Presenting Systolic Blood Pressure and Outcomes in Patients With Acute Aortic Dissection

Eduardo Bossone, Riccardo Gorla, Troy M. LaBounty, Toru Suzuki, Dan Gilon, Craig Strauss, Andrea Ballotta, Himanshu J. Patel, Arturo Evangelista, Marek P. Ehrlich, Stuart Hutchison, Eva Kline-Rogers, Daniel G. Montgomery, Christoph A. Nienaber, Eric M. Isselbacher, Kim A. Eagle

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Presenting systolic blood pressure (SBP) is a powerful predictor of mortality in many cardiovascular settings, including acute coronary syndromes, cardiogenic shock, and acute heart failure. Objectives: This study evaluated the association of presenting SBP with in-hospital outcomes, specifically all-cause mortality, in acute aortic dissection (AAD). Methods: The study included 6,238 consecutive patients (4,167 with type A and 2,071 with type B AAD) enrolled in the International Registry of Acute Aortic Dissection. Patients were stratified in 4 groups according to presenting SBP: SBP >150, SBP 101 to 150, SBP 81 to 100, or SBP ≤80 mm Hg. Results: The relationship between presenting SBP and in-hospital mortality displayed a J-curve association, with significantly higher mortality rates in patients with very high SBP (26.3% for SBP >180 mm Hg in type A AAD, 13.3% for SBP >200 mm Hg in type B AAD; p = 0.005 and p = 0.018, respectively) as well as in those with SBP ≤100 mm Hg (29.9% in type A, 22.4% in type B; p = 0.033 and p = 0.015, respectively). This relationship was mainly from increased rates of in-hospital complications (acute renal failure, coma, and mesenteric ischemia/infarction in patients with SBP >150 mm Hg; stroke, coma, cardiac tamponade, myocardial ischemia/infarction, and acute renal failure in patients with SBP ≤80 mm Hg). Notably, presenting SBP ≤80 mm Hg was independently associated with in-hospital mortality in both type A (p = 0.001) and type B AAD (p = 0.003). Conclusions: Presenting SBP showed a clear J-curve relationship with in-hospital mortality in patients with AAD. Although this association was related to increased rates of comorbid conditions at the edges of the curve, SBP ≤80 mm Hg was an independent correlate of in-hospital mortality.

Original languageEnglish
Pages (from-to)1432-1440
Number of pages9
JournalJournal of the American College of Cardiology
Volume71
Issue number13
DOIs
Publication statusPublished - Apr 3 2018

Keywords

  • blood pressure
  • J-curve
  • type A aortic dissection
  • type B aortic dissection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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