Onset seasons and clinical outcomes in patients with Stanford type A acute aortic dissection: an observational retrospective study

Zhaoran Chen; Bi Huang; Yanmin Yang; Rutai Hui; Haisong Lu; Zhenhua Zhao; Zhinan Lu; Shu Zhang; Xiaohan Fan

doi:10.1136/bmjopen-2016-012940

Onset seasons and clinical outcomes in patients with Stanford type A acute aortic dissection: an observational retrospective study

BMJ Open. 2017 Feb 27;7(2):e012940. doi: 10.1136/bmjopen-2016-012940.

Authors

Zhaoran Chen¹, Bi Huang¹, Yanmin Yang¹, Rutai Hui¹, Haisong Lu², Zhenhua Zhao², Zhinan Lu¹, Shu Zhang¹, Xiaohan Fan¹

Affiliations

¹ State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Beijing, China.
² State Key Laboratory of Cardiovascular Disease, Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Beijing, China.

Abstract

Objectives: To evaluate the association of onset season with clinical outcome in type A acute aortic dissection (AAD).

Design: A single-centre, observational retrospective study.

Setting: The study was conducted in Fuwai Hospital, the National Centre for Cardiovascular Disease, Beijing, China.

Participants: From 2008 to 2010, a set of consecutive patients with type A AAD, confirmed by CT scanning, were enrolled and divided into four groups according to onset season: winter (December, January and February), spring (March, April and May), summer (June, July and August) and autumn (September, October and November). The primary end points were in-hospital death and all-cause mortality during follow-up.

Results: Of the 492 cases in this study, 129 occurred in winter (26.2%), 147 in spring (29.9%), 92 in summer (18.7%), and 124 in autumn (25.2%). After a median follow-up of 20.4 months (IQR 9.7-38.9), the in-hospital mortality in cases occurring in autumn was higher than in the other three seasons (23.4% vs 8.4%, p<0.01). Long-term mortality was comparable among the four seasonal groups (p=0.63). After adjustment for age, gender and other risk factors, onset in autumn was still an independent factor associated with increased risk of in-hospital mortality (HR 2.05; 95% CI 1.15 to 3.64, p=0.02) in addition to surgical treatment. Further analysis showed that the seasonal effect on in-hospital mortality (autumn vs other seasons: 57.4% vs 27.3%, p<0.01) was only significant in patients who did not receive surgical treatment. No seasonal effect on long-term clinical outcomes was found in this cohort.

Conclusions: Onset in autumn may be a factor that increases the risk of in-hospital death from type A AAD, especially in patients who receive conservative treatment. Immediate surgery improves the short-term and long-term outcomes regardless of onset season.

Keywords: Stanford type A; acute aortic dissection; autumn; in-hospital death; onset seasons.

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Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aortic Aneurysm / mortality*
Aortic Aneurysm / therapy
Aortic Dissection / mortality*
Aortic Dissection / therapy
Beijing
Female
Hospital Mortality
Humans
Male
Middle Aged
Retrospective Studies
Risk Factors
Seasons*
Survival Analysis
Treatment Outcome