Incidence and characteristics of acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest evaluated by non-contrast computed tomography

Abstract

Background The exact epidemiology of acute aortic dissection, including cases of out-of-hospital cardiopulmonary arrest, is unclear. We aimed to investigate the incidence and characteristics of acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest transferred to our institution and validate the related factors to out-of-hospital cardiopulmonary arrest in Stanford type A acute aortic dissection. Methods We retrospectively reviewed the acute-phase computed tomography data of patients with out-of-hospital cardiopulmonary arrest who visited our hospital between 1 January 2015 and 31 December 2017. Results Among 1011 consecutive patients with out-of-hospital cardiopulmonary arrest, excluding those aged 17 years and younger and exogenous out-of-hospital cardiopulmonary arrest, such as suicide and trauma, 934 underwent computed tomography examination and 71 (7.6%) were diagnosed with acute aortic dissection: 66 with Stanford type A and five with type B acute aortic dissection (out-of-hospital cardiopulmonary arrest group). Seventy-five patients without out-of-hospital cardiopulmonary arrest with Stanford type A acute aortic dissection visited our institution during the same period (non-out-of-hospital cardiopulmonary arrest group). Age, incidence of massive bloody pericardial effusion and massive intrathoracic haemorrhage were significantly higher in the out-of-hospital cardiopulmonary arrest than in the non-out-of-hospital cardiopulmonary arrest group (78 ± 8 years, 72.7% and 24.2% vs. 70 ± 13 years, 26.7% and 1.3%, respectively; all P < 0.01). These variables were independently related to out-of-hospital cardiopulmonary arrest. Conclusions There may be more patients with acute aortic dissection with out-of-hospital cardiopulmonary arrest than previously thought. Aortic rupture into the pericardial space or thoracic cavity is the major cause of out-of-hospital cardiopulmonary arrest in these cases. Non-contrast computed tomography can be used to diagnose acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest. Our study is one of a few to evaluate the real circumstances surrounding acute aortic dissection and its epidemiology.

Incidence of acute aortic dissections in patients with out of hospital cardiac arrest: A systematic review and meta-analysis of observational studies

“…Up to this point, there are few studies on AAD patients presenting as OHCA, with its epidemiology and patient characteristics remaining mostly unknown [2] . Recent studies have suggested that its incidence is higher than previously reported [3] , [4] ..…”

The Difference of ACE and ACE2 Gene Expression in Patients With Acute Aortic Dissection and Coronary Heart Disease

“…MMP.1, MMP.2, and MMP.9 have been con rmed in a number of experiments to be related to the occurrence of aortic dissection/aneurysm [4][5]. Therefore, AngII may promote the occurrence of aortic dissection [6], and studies have shown that the RAS system plays a role in the occurrence of abdominal aortic aneurysm [7]. Although experiments found that ACE activity in cardiovascular diseases such as heart failure, hypertension, and angina pectoris was signi cantly increased in the disease group [8-10], the detection of peripheral venous blood ACE concentration in this experiment showed contradictory results.…”

New clues for optimal diagnosis and treatment of an old foe: the acute aortic syndrome

“…The majority had type A pathology versus type B (66 vs. 5) with mechanisms for arrest including pericardial effusion and massive haemorrhage. 2 These findings suggest that acute aortic syndromes play a relevant role in cardiac arrest and underscore the need for greater diagnostic awareness as well as improved prevention.…”

“…However, the broad availability of high quality axial imaging with computed tomography (CT) has led to greater recognition of acute aortic syndromes as a cause of OHCA. Takeuchi et al 2 describe the findings in a single centre series of 1011 patients with OHCA with 934 undergoing CT and found that 7.6% had an acute aortic syndrome, a frequency that is strikingly high. The majority had type A pathology versus type B (66 vs. 5) with mechanisms for arrest including pericardial effusion and massive haemorrhage.…”