Relationship Between Heart Rate Control And Prognosis In Patients With Acute Aortic Dissection

ObjectiveTo observe the correlation between heart rate control level and in-hospital mortality in patients with acute aortic dissection after admission.MethodsThe clinical data of 307 patients with confirmed acute aortic dissection treated in our hospital from January 2011 to June 2018 were retrospectively analyzed,including 100 patients with Stanford type A and 207 patients with Stanford type B.According to the prognosis,they were divided into death group(48 cases)and survival group(259 cases).The average heart rate within 72 hours after admission was divided into four groups: <70beats/min(44 cases),70-80 beats/min(92 cases),80-90 beats/min(94 cases)and >90beats/min(77 cases).General clinical data were compared according to the presence or absence of death and heart rate level,and risk factors related to in-hospital death were analyzed by multiple logistic regression.ResultsThe in-hospital mortality rate of AAD patients was 15.6%.In the death group,the proportion of Stanford type A,drug treatment alone,in-hospital combined organ ischemia symptoms(heart,kidney,neurovascular)and arcuate vascular imaging involvement was significantly higher than that in the survival group,and the length of hospital stay was significantly shorter than that in the survival group(all p < 0.05);the proportion of endovascular treatment,periaortic hematoma,CCB drugs and beta blockers used in thesurvival group was significantly higher than that in the death group,and the mean systolic and diastolic blood pressure were higher than that in the death group,and the heart rate was lower than that in the death group(all p< 0.05).Hemoglobin,platelet count,albumin,bicarbonate and high density lipoprotein in the death group were lower than those in the survival group,and APTT and ascending aorta diameter were higher than those in the survival group(all p <0.05).In the heart rate grouping,the Stanford type A ratio,mortality rate,single-agent treatment ratio,and imaging manifestations of arcuate vascular involvement in the group with heart rate >90 beats/min were significantly higher than those in the other groups,and the length of hospital stay was significantly shorter than that in the other groups(all p<0.05).In patients with heart rate fluctuations of 70-90 beats/min,The proportion of Stanford type B,survival rate and proportion of endovascular therapy were significantly higher than other groups(all p<0.05);patients with heart rate fluctuation of 70 beats/min were older and had no obvious chest pain symptoms compared with other groups(all p<0.05);with the increase of heart rate,systolic/diastolic blood pressure increased secondarily,and the history of previous hypertension increased(all p<0.05).Multivariate regression analysis showed that heart rate >90 beats/min and disturbance of consciousness were independent risk factors for in-hospital death,and beta blockers and endovascular therapy were independent protective factors for in-hospital death(all p<0.05).CONCLUSIONPatients with acute aortic dissection with heart rate >90 beats/min have a significantly increased risk of in-hospital death with disturbance of consciousness.Regular use of beta blockers and timely endovascular treatment can significantly reduce the risk of hospital death.