Analysis Of Factors Associated With Cerebral Infarction After Acute Stanford Type A Aortic Dissection

Objective: To analyze the risk factors associated with cerebral infarction in patients with acute Stanford type A aortic dissection(ATAAD).Methods: A retrospective analysis was performed on the data of 137 patients with ATAAD who underwent surgery in the First Hospital of Hebei Medical University from January 2019 to September 2022,and divided into cerebral infarction group(n=28)and non-cerebral infarction group(n=109)according to whether postoperative cerebral infarction was complicated,compared the general data of the two groups before,during and after surgery,and used binary logistic regression to analyze the relevant factors of postoperative cerebral infarction in ATAAD patients.The ROC curve explores the predictive value of related factors on whether cerebral infarction is complicated after surgery.Results:1.The average age of patients 54.24 years old,including 94 males(68.6%),43 females(31.4%),28(20.4%)patients complicated by cerebral infarction after surgery,35(25.5%)patients died during hospitalization,among which the mortality rate of patients in the cerebral infarction group was significantly higher than that in the non-cerebral infarction group(53.6% VS18.3%).Patients in both groups had systolic blood pressure on admission,history of diabetes,creatinine,Aspartate aminotransferase(AST),D-dimer,fibrinogen(FIB),cardiopulmonary bypass(CPB)time,aortic occlusion time,intraoperative blood loss,intensive care unit(ICU)time,The differences in duration of mechanical ventilation,postoperative hemofiltration,and mortality during hospitalization were statistically significant(all P<0.05).2.Results of multivariate logistic regression analysis: the influence of confounding factors was excluded,and D-dimer(OR=1.055;95%CI:1.001-1.113;P=0.048),aortic occlusion time(OR=1.077;95%CI: 1.019-1.139;P=0.009)is an independent risk factor for postoperative cerebral infarction.3.ROC results showed that D-dimer(AUC: 0.831;95%CI: 0.660-0.862;P<0.001)and aortic occlusion time(AUC: 0.864;95%CI: 0.757-0.905;P<0.001)had a certain predictive effect on postoperative complicated cerebral infarction,and the combined prediction value of the two was better(AUC:0.900;95%CI: 0.826-0.974;P<0.001).Conclusion: The incidence of cerebral infarction complicated by acute Stanford type A aortic dissection is high,and the mortality rate of postoperative cerebral infarction patients during hospitalization is high,and preoperative D-dimer and aortic occlusion time are risk factors,which have predictive value for postoperative cerebral infarction.