Patients With Type A Acute Aortic Dissection Presenting With an Abnormal Electrocardiogram

Nathaniel I. Costin, Amit Korach, Gabriel Loor, Mark D. Peterson, Nimesh D. Desai, Santi Trimarchi, Carlo de Vincentiis, Takeyoshi Ota, T. Brett Reece, Thoralf M. Sundt, Himanshu J. Patel, Edward P. Chen, Dan G. Montgomery, Christoph A. Nienaber, Eric M. Isselbacher, Kim A. Eagle, Thomas G. Gleason

Research output: Contribution to journalArticle

Abstract

Background 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. Methods 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). Results 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%, p < 0.001), especially in those with ischemia by ECG (25.7% vs 16.8%, p < 0.001) and infarction with new Q waves or ST elevation (30.1% vs 17.1%, p < 0.001). Conclusions 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.

Original languageEnglish
Pages (from-to)92-99
Number of pages8
JournalAnnals of Thoracic Surgery
Volume105
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Costin, N. I., Korach, A., Loor, G., Peterson, M. D., Desai, N. D., Trimarchi, S., de Vincentiis, C., Ota, T., Reece, T. B., Sundt, T. M., Patel, H. J., Chen, E. P., Montgomery, D. G., Nienaber, C. A., Isselbacher, E. M., Eagle, K. A., & Gleason, T. G. (2018). Patients With Type A Acute Aortic Dissection Presenting With an Abnormal Electrocardiogram. Annals of Thoracic Surgery, 105(1), 92-99. https://doi.org/10.1016/j.athoracsur.2017.06.063