Onset seasons and clinical outcomes in patients with Stanford type A acute aortic dissection: an observational retrospective study. Issue 2 (27th February 2017)

• Record Type: Journal Article
• Authors: Chen, Zhaoran; Huang, Bi; Yang, Yanmin; Hui, Rutai; Lu, Haisong; Zhao, Zhenhua; Lu, Zhinan; Zhang, Shu; Fan, Xiaohan
• Is Part Of: BMJ open. Volume 7:Issue 2(2017)
• Publication Date: 2017-02-27
• Subjects: acute aortic dissection -- onset seasons -- autumn -- in-hospital death -- Stanford type A; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2016-012940
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: To evaluate the association of onset season with clinical outcome in type A acute aortic dissection (AAD). Design: A single-centre, observational retrospective study. Setting: The study was conducted in Fuwai Hospital, the National Centre for Cardiovascular Disease, Beijing, China. Participants: From 2008 to 2010, a set of consecutive patients with type A AAD, confirmed by CT scanning, were enrolled and divided into four groups according to onset season: winter (December, January and February), spring (March, April and May), summer (June, July and August) and autumn (September, October and November). The primary end points were in-hospital death and all-cause mortality during follow-up. Results: Of the 492 cases in this study, 129 occurred in winter (26.2%), 147 in spring (29.9%), 92 in summer (18.7%), and 124 in autumn (25.2%). After a median follow-up of 20.4 months (IQR 9.7–38.9), the in-hospital mortality in cases occurring in autumn was higher than in the other three seasons (23.4% vs 8.4%, p<0.01). Long-term mortality was comparable among the four seasonal groups (p=0.63). After adjustment for age, gender and other risk factors, onset in autumn was still an independent factor associated with increased risk of in-hospital mortality (HR 2.05; 95% CI 1.15 to 3.64, p=0.02) in addition to surgical treatment. Further analysis showed that the seasonal effect on in-hospital mortality (autumn vs other seasons: 57.4% vs 27.3%, p<0.01) was only significant in patients who did not receive surgical treatment. No seasonal effect on long-term clinical outcomes was found in this cohort. Conclusions: Onset in autumn may be a factor that increases the risk of in-hospital death from type A AAD, especially in patients who receive conservative treatment. Immediate surgery improves the short-term and long-term outcomes regardless of onset season.