[Risk factors for adverse prognosis in acute aortic syndrome: a single-center retrospective cohort study].

Abstract

Objective: To explore the prognosis of patients with acute aortic syndrome (AAS) in the real world and to examine the risk factors associated with poor outcomes in AAS. Methods: This is a single-center retrospective study. Patients diagnosed with AAS at Xinqiao Hospital from January 2021 to July 2023 were included. The primary endpoints were all-cause mortality and aorta-related mortality, while the secondary endpoints included stroke, myocardial infarction, secondary interventions, and readmission for any cause. Survival analysis was performed using Kaplan-Meier curves, and risk factors for primary endpoint events were analyzed using multivariate Cox regression. Results: A total of 254 AAS patients, aged (58.9±13.2) years were included in this study. There were 178 cases of aortic dissection, 69 cases of aortic intramural hematoma, and 7 cases of aortic penetrating ulcer. The median follow-up time was 545 days. Seventy-three all-cause deaths occurred among patients with AAS, including 61 aorta-related deaths; 3 strokes, 1 myocardial infarction, 9 secondary surgeries, and 35 readmissions for any cause were observed. Kaplan-Meier curve analysis demonstrated significant differences in all-cause mortality rates based on the Stanford classification, AAS disease classification, eGFR, and albumin levels (all P<0.05), and similar results were also observed in aorta-related death (all P<0.05). Multivariate Cox regression suggested that albumin<35 g/L (HR=2.372, 95%CI 1.337-4.210, P=0.003), eGFR<90 ml·min^-1·1.73 m^-2 (HR=2.457, 95%CI 1.261-4.786, P=0.008), and Stanford type A AAS (HR=3.420, 95%CI 1.998-5.856, P<0.001) were independent risk factors for all-cause mortality in AAS patients; albumin<35 g/L(HR=2.432, 95%CI 1.295-4.570, P=0.006), eGFR<90 ml·min^-1·1.73 m^-2(HR=2.523,95%CI 1.243-5.122,P=0.010), and Stanford type A AAS (HR=3.455,95%CI 1.819-6.564,P<0.001) were independent risk factors for aorta-related mortality in AAS patients. Conclusions: In the real world, the prognosis of patients with AAS remains pessimistic. Patients with type A AAS, renal dysfunction, hypoproteinemia may have a higher risk of poor prognosis.