Abstract 17095: Clinical Characteristics and Short-term Outcomes of Aortic Disease Patients With Cardiovascular Shock: Results From the Shock Registry of the Japanese Circulation Society

Abstract

Background: The mortality rate of aortic disease patients with cardiovascular shock (CVS) is still high. We examined the factors related to short-term outcomes of aortic disease patients with CVS. Methods: The Japanese Circulation Society Shock Registry was a prospective, observational, multi-center (83 institutions), cohort study that enrolled 980 patients presenting with CVS when transported to the emergency room between May 2012 and June 2014. Of those, 82 aortic dissection (AD) and 63 aortic aneurysm (AA) patients were enrolled in this study. Because each institution used a different D-dimer kit, adjusted D-dimer levels were calculated by dividing the measured D-dimer value by the upper limit of the normal range of the kit. Results: The mean age was 76 years and 52% were male. The 30-day mortality rate was 46% (AD, 39%; AA, 56%). In AD, Stanford type A accounted for 95% and surgical intervention was performed in 68%. In AA, 24% were thoracic; 6%, thoracoabdominal; 69%, abdominal AA, and surgical intervention was performed in 57%. In AD, adjusted D-dimer levels on admission of non-survivors were significantly higher than those of survivors [median (interquartile range): 75.6 (19.5-229.4) vs. 25.8 (8.0-61.3) arbitrary units, respectively; P=0.01]. In AD, surgical intervention, a transferred case, absence of aortic rupture, and low D-dimer levels (adjusted D-dimer < 33.2 arbitrary units, which was the median value) were associated with the 30-day survival. In AA, surgical intervention, a transferred case, higher consciousness level, higher systolic blood pressure, and abdominal AA were associated with 30-day survival. Cox proportional hazards analysis indicated that surgical intervention (hazard ratio 0.14; 95%CI, 0.049-0.40; P<0.001) and low D-dimer level (hazard ratio 0.21; 95%CI, 0.067-0.57; P<0.001) were independent predictors of 30-day survival in AD, and surgical intervention (hazard ratio 0.087; 95%CI, 0.023-0.28; P<0.001) was an independent predictor of 30-days survival in AA. Conclusions: Surgical intervention was the only method to improve short-term outcomes of aortic disease patients with CVS. In AD, lower D-dimer level was associated with more favorable short-term outcomes regardless of surgical intervention.