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Patients With Type A Acute Aortic Dissection Presenting With an Abnormal Electrocardiogram
- Source :
- The Annals of thoracic surgery. 105(1)
- Publication Year :
- 2017
-
Abstract
- The electrocardiogram (ECG) is often used in the diagnosis of patients presenting with chest pain to emergency departments. Because chest pain is a common manifestation of type A acute aortic dissection (TAAAD), ECGs are obtained in much of this population. We evaluated the effect of particular ECG patterns on the diagnosis and treatment of TAAAD.TAAAD patients (N = 2,765) enrolled in the International Registry of Acute Aortic Dissection were stratified based on normal (n = 1,094 [39.6%]) and abnormal (n = 1,671 [60.4%]) findings on presenting ECGs and further subdivided according to specific ECG findings. Time data are presented in hours as medians (quartile 1 to quartile 3).Patients with ECGs with abnormal findings presented to the hospital sooner after symptom onset than those with ECGs with normal findings (1.4 [0.8 to 3.3] vs 2.0 [1.0 to 3.3]; p = 0.005). Specifically, this was seen in patients with infarction with new Q waves or ST elevation (1.3 [0.6 to 2.7] vs 1.5 [0.8 to 3.3]; p = 0.049). Interestingly, the time between symptom onset and diagnosis was longer with infarction with old Q waves (6.7 [3.2 to 18.4] vs 5.0 [2.9 to 11.8]; p = 0.034) and nonspecific ST-T changes (5.8 [3.0 to 13.8] vs 4.5 [2.8 to 10.5]; p = 0.002). Surgical mortality was higher in patients with abnormal ECG findings (20.6% vs 11.9%, p0.001), especially in those with ischemia by ECG (25.7% vs 16.8%, p0.001) and infarction with new Q waves or ST elevation (30.1% vs 17.1%, p0.001).TAAAD patients presenting with abnormal ECG results are sicker, have more in-hospital complications, and are more likely to die. The frequency of nonspecific ST-T abnormalities and its association with delay in diagnosis and treatment presents an opportunity for practice improvement.
- Subjects :
- Pulmonary and Respiratory Medicine
Male
medicine.medical_specialty
Population
Infarction
030204 cardiovascular system & hematology
Chest pain
03 medical and health sciences
Aortic aneurysm
Electrocardiography
0302 clinical medicine
Internal medicine
medicine
Humans
030212 general & internal medicine
education
Aged
Retrospective Studies
Aortic dissection
education.field_of_study
medicine.diagnostic_test
Aortic Aneurysm, Thoracic
business.industry
ST elevation
Middle Aged
medicine.disease
Aortic Dissection
Quartile
Acute Disease
Cardiology
Surgery
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 15526259
- Volume :
- 105
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- The Annals of thoracic surgery
- Accession number :
- edsair.doi.dedup.....9b9cf0c6766e0091c6a0353c54bf3997