Type A acute aortic dissection complicated by preoperative myocardial infarction: Insights from the International Registry of Acute Aortic Dissection

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Objectives Type A acute aortic dissection can cause preoperative myocardial infarction due to coronary malperfusion or hemodynamic collapse. This study aims to characterize the presentation, management, and outcomes of patients with concomitant dissection and myocardial infarction. Methods A total of 5762 patients with type A dissection were evaluated from the International Registry of Acute Aortic Dissection from 1996 to 2024. Patients with endovascular management, iatrogenic dissection, or insufficient data were excluded. Patients with preoperative myocardial infarction (n = 662, 10.8%) were compared with those without preoperative myocardial infarction (n = 5140, 89.2%). Results Age and time to diagnosis and treatment were similar between groups. Patients with preoperative myocardial infarction more frequently presented with chest pain (88.6% vs 82.0%, P < .0001) and hemodynamic shock (9.5% vs 6.4%, P = .009). Diagnostic imaging revealed more coronary involvement (39.4% vs 14.3%, P < .0001). Surgery more often involved coronary artery bypass grafting (25.4% vs 8.3%, P < .0001) and root replacement (43.9% vs 35%, P = .0003) in the preoperative myocardial infarction group. Patients with preoperative myocardial infarction had higher rates of low output syndrome (9.5% vs 2.2%, P < .0001), renal failure (31.2% vs 21.1%, P < .0001), coma (5.4% vs 2.8%, P = .006), and in-hospital mortality (33.3% vs 15.6%, P < .0001). However, 4-year survival was similar ( P = .810). Preoperative myocardial infarction remained an independent predictor of in-hospital mortality on multivariable analysis (odds ratio, 2.27, P < .0001). Conclusions Patients with type A acute aortic dissection and preoperative myocardial infarction experienced higher complication and in-hospital mortality rates. Earlier recognition and targeted surgical strategies may improve outcomes.

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