Abstract 9919: ST-Segment Elevation in Lead aVR is the Strongest Predictor of 30-Day Mortality in Patients With Type A Acute Aortic Dissection

Abstract

Introduction: We investigated the prognostic value of ST-segment elevation in lead aVR (ST↑aVR) at presentation ECG in type A acute aortic dissection (AAD). Hypothesis: In type A AAD, ischemic ST-T changes at presentation have been shown to be associated with poor outcomes. ST↑aVR, an ECG marker of severe acute myocardial ischemia, may provide important prognostic information. Methods: We studied the relation of ECG findings to clinical features on admission and 30-day mortality in 280 patients who were admitted within 6 h from symptom onset and underwent emergency surgery for type A AAD. Patients with bundle branch block or left ventricular hypertrophy were excluded. Patients were divided into the 3 groups according to admission ECG findings: no significant ST-T changes (n=96, G-A); the absence (n=142, G-B) or the presence (n=42, G-C) of ST↑aVR ≥0.5 mm with ST-T changes in other leads. Estimated glomerular filtration rate (eGFR) was measured on admission, and renal dysfunction was defined as an eGFR <60 ml/min per 1.73 m2. Results: There were no differences in age, sex or time from symptom onset to admission in the 3 groups. In G-A, G-B, and G-C, the rates of renal dysfunction were 41%, 56%, and 67% (p<0.01); shock were 2%, 22%, and 71% (p<0.01); cardiac tamponade was 3%, 18%, and 67% (p<0.01); moderate/severe aortic regurgitation was 4%, 28%, and 43% (p<0.01); coronary ostial involvement was 3%, 11%, and 32% (p<0.01); left coronary artery involvement was 2%, 1%, and 17% (p<0.01); right coronary artery involvement was 1%, 9%, and 10% (p<0.05); and both left and right coronary artery involvement was 0%, 1%, and 5% (p=0.10); coronary artery bypass surgery was 2%, 7%, and 12% (p=0.07); aortic valve repair/replacement was 1%, 6%, and 10% (p=0.06); 30-day mortality was 1%, 6%, and 33% (p<0.01), respectively. After adjusting baseline characteristics, multivariate analysis showed that ST↑aVR (OR 38.4, 95%CI 8.10-82.0, p<0.01) was the strongest predictor of 30-day death, followed by renal dysfunction (OR 5.85, 95%CI 1.70-20.1, p<0.01). Conclusions: In patients with type A AAD who underwent emergency surgery, ST↑aVR on admission ECG was the strongest predictor of 30-day mortality. Our findings suggest the importance of ST↑aVR in early risk stratification for type A AAD.