Abstract 14879: Circadian Variation in Pre-Procedural Rupture of Acute Type A Aortic Dissection

Abstract

Introduction: Acute type A aortic dissection (ATAAD) is a devasting cardiovascular disease. Though it is recommended by guidelines, urgent open surgery was not accessible for all patients. Transferring patients to comprehensive aortic centers, inadequate medical assistance in low-resource health systems or financial issues would delay the timing of surgery. There have been several reports about the connection between circadian variation and cardiovascular disease. The study was conducted to examine the circadian variation in pre-procedural rupture of ATAAD in the hospital. Methods: The study enrolled ATAAD patients who died from aortic rupture within 7 days since onset in our center from January 2010 to December 2020. Patients who died within 1 hour after admission were excluded. All patients accepted anti-impulse therapy immediately upon admission. Clinical data were retrospectively collected from medical records. Results: In total, 200 ATAAD patients were enrolled in the retrospective observational study. Mean age of recruiters was 55.98 ± 11.82 years and 159 (78.5%) were men. Mean time from onset to admission was 26.78 ± 24.97 hours and mean time from onset to rupture was 48.27 ± 42.01 hours. Distributions of rupture time were visualized through histogram. The peaks of the occurrence of aortic rupture were in 6:00-8:00 (26%) and 18:00-22:00 (36%). Kernel density estimation was consistent with the results. Conclusions: Rupture of ATAAD does not seem to be a random phenomenon, while the peak of occurrence was consistent with the circadian rhythm. Even when the hemodynamic state was well controlled, fluctuant blood pressure and heart rate that influenced by the circadian rhythm would increase the risk of aortic rupture. During 6:00-8:00 and 18:00-22:00, more frequent blood pressure measurement and does adjustment of intravenous anti-impulse drugs might improve aortic rupture reduction. What’s more, bedtime hypertension treatment might also help.