Effect Of Preoperative Heart Rate On Perioperative Aorta-Related Adverse Event In Patients With Acute Standford Type B Aortic Dissection

Objective To investigate the effect of preoperative heart rate on perioperative aortic-related adverse event(ARAE)in patients with acute Standford type B aortic dissection(AD).Methods The clinical data of 232 patients with acute Standford type B AD from January 2017 to June 2019 in our hospital were retrospectively analyzed.(1)Logistic regression was used to analyze the independent risk factors affecting the occurrence of ARAE;(2)ROC curve was used to obtain the diagnostic cut-off value of preoperative heart rate for predicting the occurrence of ARAE in patients with acute Standford type B AD,and the patients were divided into two groups A and B with different heart rates according to this value;(3)propensity score-matched(PSM)was used to control for confounding factors,and a new matched sample was used to assess the difference in the occurrence of ARAE between the two groups of patients with different heart rates.Results Overall cohort population:(1)Factors independently associated with the development of ARAE were female gender(P = 0.015),age(P = 0.014),history of hypertension(P =0.019),complicated dissection(P < 0.001),preoperative heart rate(P < 0.001),andsmoking history(P = 0.009).The regression equation is listed as: Logit P =-15.039 +1.474 x 1 + 0.055 x 2 + 2.163 x 3 + 1.574 x 4 + 2.458 x 5 + 0.068 x 6.(2)Preoperative heart rate level(OR = 1.071,95% CI: 1.037 ? 15.696,P < 0.001)was one of the independent factors for perioperative ARAE.(3)ROC curve yielded a diagnostic cut-off value of 87 beats/min for preoperative heart rate to predict the occurrence of ARAE in patients with acute Standford type B AD,and the patients were divided into two groups according to this value,group A(159 patients):heart rate < 87 beats/min,group B(73 patients): heart rate ? 87 beats/min.(4)Using PSM statistics,two groups A and B were matched one-to-one to obtain 66 pairs of data,whose baseline data were similar and well-matched.PSM cohort: The total number of ARAE was 28,including death in 13 patients,new AD in 1 patient,rupture in 8 patients,the need for secondary intervention in 2 patients,organ malperfusion in 2 patients,paraplegia in 0 patient and stroke in 2 patients.The incidence of ARAE(30.3%)and mortality(15.2%)in group B' were higher than those in group A'(12.1%,4.5%),and the differences were statistically significant(P < 0.05 for all).However,the incidence of dissection rupture in groups A' and B' was 3.0% and9.1%,respectively,and the difference was not statistically significant(P = 0.274).Conclusion Preoperative heart rate is an independent risk factor for ARAE in patients with acute Standford type B AD.When the heart rate is ? 87 beats/min,the incidence of ARAE is significantly increased during the perioperative period.In the absence of clear evidence to explain the heart rate control target,the preoperative heart rate of 87beats/min can be considered as a risk early warning indicator for heart rate control.