| アブストラクト | BACKGROUND: The optimal strategy for acute type A aortic dissection (ATAAD) with coronary malperfusion remains unclear. This study aimed to compare in-hospital mortality between coronary angiography followed by aortic repair and direct aortic repair without coronary angiography in patients with ATAAD and coronary malperfusion. METHODS: We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database, a nationwide inpatient database, from July 2010 to March 2022. We included patients who were admitted emergently and underwent surgery for ATAAD on the day of admission. Patients were defined as having preoperative coronary malperfusion if they had a diagnosis of acute myocardial infarction present on admission or underwent coronary angiography or percutaneous coronary intervention on the day of surgery. The primary outcome was in-hospital mortality. Patients were categorized as coronary angiography followed by aortic repair (CAG group) or direct aortic repair (DAR group). A multivariable Cox regression model was used to compare the time to in-hospital death between groups. RESULTS: We identified 1167 patients with ATAAD with coronary malperfusion. Of these, 508 (43.5 %) were in the CAG group and 659 (56.5 %) were in the DAR group. Cox regression analysis revealed no significant differences in the in-hospital mortality between the groups (hazard ratio, 1.05; 95 % confidence interval, 0.83 to 1.34, p = 0.661). CONCLUSIONS: Among patients with ATAAD with coronary malperfusion, in-hospital mortality did not differ significantly between those who underwent coronary angiography followed by aortic repair and those who underwent direct aortic repair. |
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| 投稿者 | Fukano, Kentaro; Sasabuchi, Yusuke; Matsui, Hiroki; Iizuka, Yusuke; Yamaguchi, Atsushi; Sanui, Masamitsu; Yasunaga, Hideo |
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| 組織名 | Department of Anesthesiology and Critical care medicine, Jichi Medical University;Saitama Medical Center, Saitama-shi, Saitama-ken, Japan.;Department of Real-world Evidence, Graduate School of Medicine, The University of;Tokyo, Bunkyo-ku, Tokyo, Japan.;Department of Clinical Epidemiology and Health Economics, School of Public;Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.;Saitama Medical Center, Saitama-shi, Saitama-ken, Japan. Electronic address:;yiizuka@jichi.ac.jp.;Department of Cardiovascular Surgery, Jichi Medical University Saitama Medical;Center, Saitama-shi, Saitama-ken, Japan.;Division of Intensive Care, Department of Anesthesiology and Intensive Care;Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi-ken,;Japan. |
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