Right versus left coronary artery involvement in patients with type A acute aortic dissection. (15th January 2023)

• Record Type: Journal Article
• Authors: Saito, Yuichi; Hashimoto, Osamu; Nakayama, Takashi; Sasaki, Haruka; Yumoto, Keita; Oshima, Susumu; Tobaru, Tetsuya; Kushida, Shunichi; Kanda, Junji; Sakai, Yoshiaki; Okino, Shinichi; Fukuzawa, Shigeru; Abiko, Akihiko; Itoh, Tomonori; Nakamura, Yoshitake; Nakashima, Takahiro; Yasuda, Satoshi; Goto, Kenji; Takebayashi, Hideo; Oshitomi, Takashi; Sakamoto, Tomohiro; Kojima, Sunao; Otsuka, Yoritaka; Himi, Toshiharu; Inagaki, Yusuke; Yamaguchi, Junichi; Hagiya, Kenichi; Nanasato, Mamoru; Kobayashi, Yoshio
• Is Part Of: International journal of cardiology. Volume 371(2023)
• Page Start: 49
• Page End: 53
• Publication Date: 2023-01-15
• Subjects: Type A aortic dissection -- Coronary artery involvement -- Surgery -- Percutaneous coronary intervention -- Outcomes; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.10.021
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Type A acute aortic dissection (AAD) complicated by coronary malperfusion is a life-threatening disease. In the present study, we compared the clinical characteristics and prognostic impact of treatment strategies including surgical treatment and percutaneous coronary intervention (PCI) in type A AAD patients with RCA and LCA involvement. Methods: This multicenter registry included 220 patients with type A AAD and either RCA or LCA involvement. Treatment strategies were left to treating physicians. The primary endpoint was in-hospital death. Results: Of 220 patients, 115 (52.3%) and 105 (47.7%) had RCA and LCA involvement. Patients with LCA involvement were more1 likely to present with Killip class IV on admission than those with RCA involvement. Coronary angiography was performed in 52 of 220 (23.6%) patients, among whom 39 (75.0%) underwent subsequent PCI. During the hospitalization, 93 (42.3%) patients died. Patients with LCA involvement had an increased risk of in-hospital mortality compared to those with RCA involvement (54.3% vs. 31.3%, p < 0.001). In patients with RCA involvement, multivariable analysis identified Killip class IV and no surgical treatment as predictors of in-hospital death, while PCI and surgical treatment were indicated as factors associated with lower in-hospital mortality in patients with LCA involvement. Conclusions: The rates of RCA and LCA involvement were similar in type A AAD. Immediate PCI as a bridge to subsequent surgical treatment might improve survival in patients with type A AAD complicated by coronary malperfusion, especially in those with LCA involvement. Highlights: Type A acute aortic dissection (AAD) with coronary malperfusion is a fatal disease. Prognostic impact of PCI in this setting is unclear. Primary PCI may improve survival in type A AAD patients with coronary malperfusion. The PCI effect was primarily seen in patients with left coronary artery involvement.