| Objective: To evaluate the clinical features of patients with acute aortic dissection(AAD) in different Stanford types, and explore the risk factors and prognostic significance. Methods: We retrospectively analyzed the clinical data and predictors of the prognosis in 105 patients with AAD(37 with Stanford type A and 68 with Stanford type B) of Tianjin Medical University General Hospital and Tianjin 4th Central Hospital from Jan.2014 to Nov.2015. Results: Patients with Marfan syndrome and Bicuspid aortic valve of type A AAD accounted for 24.3%、8.1% separately, which were significantly higher than those of of type B AAD(7.4%, 0.0%)(P <0.05).The proportion of iatrogenic cause of dissection in Type A AAD(8.1%) was significantly higher than that in type B AAD(0.0%)(P <0.05). The incidence of the chest pain in type A group(91.9%) was higher than that in type B group(75.0%)(P<0.05). The incidence of the abdominal pain and the leg pain in type B group(32.4%,22.1%, separately) were higher than those in type A group(10.8%, 5.4%)(P <0.05). There was no difference of the incidence of the back pain between the type A group and the type B group. The incidence of the shock in type A group(16.2%) was higher than that in type B group(2.9%)(P<0.05). ECG showed the proportion of myocardial ischemia in type A group(29.7%) was higher than that in type B group(7.4%)(P<0.05), while there was no difference of the incidence of myocardial infarction between the type A group and the type B group. The number of the utility of open surgery in patients with type A AAD(64.9%) was higher than that in patients with type B AAD(2.9%)(P<0.05). Endovascular treatment was used in patients with type B AAD, with more ratio(70.6%) than that in patients with type A AAD(5.4%)(P<0.05). There was no difference of the utility of the conservative treatment and hybrid treatment between the type A group and the type B group. Computed tomography angiography(CTA) showed the proportion of involvement of aortic arch and pericardial effusion(86.5, 18.9%, separately)in the type A group were higher than those in the type B group(23.5%, 5.9%)(P<0.05). There was no difference of the incidence of pleural effusion, periaortic hematoma and false lumen thrombosis between the type A group and the type B group.Conclusion: Systolic blood pressure, pericardial effusion, periaortic hematoma, conservative treatment and open surgery were independent predictors for increased mortality in patients with AAD. |
