Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection
Vascular compromise seen with pulse deficits is common in patients with type A dissection. However, patient characteristics and in-hospital outcomes associated with pulse deficits have not been evaluated. Accordingly, we studied 513 patients (mean age 62 ± 14 years, 65% men) with acute type A aortic...
Gespeichert in:
| Veröffentlicht in: | The American journal of cardiology 2002-04, Vol.89 (7), p.851-855 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 855 |
|---|---|
| container_issue | 7 |
| container_start_page | 851 |
| container_title | The American journal of cardiology |
| container_volume | 89 |
| creator | Bossone, Eduardo Rampoldi, Vincenzo Nienaber, Christoph A Trimarchi, Santi Ballotta, Andrea Cooper, Jeanna V Smith, Dean E Eagle, Kim A Mehta, Rajendra H |
| description | Vascular compromise seen with pulse deficits is common in patients with type A dissection. However, patient characteristics and in-hospital outcomes associated with pulse deficits have not been evaluated. Accordingly, we studied 513 patients (mean age 62 ± 14 years, 65% men) with acute type A aortic dissection enrolled in the International Registry of Acute Aortic Dissection. Pulse deficits, defined as decreased or absent carotid or peripheral pulses as noted by clinicians and later confirmed by diagnostic imaging, at surgery or at autopsy were noted in 154 patients (30%). Age |
| doi_str_mv | 10.1016/S0002-9149(02)02198-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_230365846</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0002914902021987</els_id><sourcerecordid>111740594</sourcerecordid><originalsourceid>FETCH-LOGICAL-c387t-13a24ee87f8d44f8d06aa42d6ae2286abbb43716f625958bf8d52cbc4ee673ea3</originalsourceid><addsrcrecordid>eNqFkcFq3DAQhkVJaLZJHiFFBArtwY1GsmX7FEJom0AghyZnIctjouC1XElu2UufvbPZJTn2okHM98-IT4ydgfgKAvTFTyGELFoo289CfhES2qao37EVNHVbQAvqgK1ekSP2IaVnugJU-j07AmhFW9Vqxf4-JhyWccKUeBj4vIwJeY-Ddz7zHPgcsfcucz8VTyHNPtuRu7CeR-9s9mFK3E49X4dIDZ83xPGZGjjlxP_4_MStWzLyvJmRX3FLnHe89ymh28ZP2OFgaeXpvh6zx-_fHq5virv7H7fXV3eFU02dC1BWlohNPTR9WdIhtLWl7LVFKRttu64rVQ160LJqq6YjopKuc5TRtUKrjtn5bu4cw68FUzbPYYkTrTRSCaWrptQEVTvIxZBSxMHM0a9t3BgQZivdvEg3W6OG6ot0U1Pu43740q2xf0vtLRPwaQ_Y5Ow4RDs5n944RRAAEHe545BU_PYYTXKk0tEXRPJl-uD_85R_QGegpA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>230365846</pqid></control><display><type>article</type><title>Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Bossone, Eduardo ; Rampoldi, Vincenzo ; Nienaber, Christoph A ; Trimarchi, Santi ; Ballotta, Andrea ; Cooper, Jeanna V ; Smith, Dean E ; Eagle, Kim A ; Mehta, Rajendra H</creator><creatorcontrib>Bossone, Eduardo ; Rampoldi, Vincenzo ; Nienaber, Christoph A ; Trimarchi, Santi ; Ballotta, Andrea ; Cooper, Jeanna V ; Smith, Dean E ; Eagle, Kim A ; Mehta, Rajendra H ; International Registry of Acute Aortic Dissection (IRAD) Investigators</creatorcontrib><description>Vascular compromise seen with pulse deficits is common in patients with type A dissection. However, patient characteristics and in-hospital outcomes associated with pulse deficits have not been evaluated. Accordingly, we studied 513 patients (mean age 62 ± 14 years, 65% men) with acute type A aortic dissection enrolled in the International Registry of Acute Aortic Dissection. Pulse deficits, defined as decreased or absent carotid or peripheral pulses as noted by clinicians and later confirmed by diagnostic imaging, at surgery or at autopsy were noted in 154 patients (30%). Age <70 years, male gender, neurologic deficit(s), altered mental status, and hypotension, shock, or tamponade on admission were all significantly higher in patients with than without pulse deficits. The etiology of aortic dissection, clinical symptoms, and imaging findings were similar in the 2 groups. In-hospital complications (hypotension, coma, renal failure, and limb ischemia) and mortality (41% vs 25%, p = 0.0002) were significantly higher in patients with pulse deficit. Cox proportional-hazards regression analysis identified pulse deficit as an independent predictor of 5-day in-hospital mortality (risk ratio 2.73, 95% confidence interval 1.7 to 4.4; p <0.0001). Further, overall mortality rates increased with an increasing number of pulse deficits (p for trend <0.0001). Pulse deficits are common findings in patients with type A aortic dissection and identify those at high risk of in-hospital adverse events. This simple clinical sign should direct physicians to consider a diagnosis of aortic dissection in patients with acute chest pain, and should help identify a subgroup of patients who would benefit from more aggressive strategies.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/S0002-9149(02)02198-7</identifier><identifier>PMID: 11909573</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Aneurysm, Dissecting - complications ; Aneurysm, Dissecting - diagnosis ; Aneurysm, Dissecting - mortality ; Aneurysm, Dissecting - physiopathology ; Aortic Aneurysm - complications ; Aortic Aneurysm - diagnosis ; Aortic Aneurysm - mortality ; Aortic Aneurysm - physiopathology ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology ; Cardiology. Vascular system ; Chest Pain - etiology ; Diagnosis, Differential ; Diseases of the aorta ; Female ; Hospital Mortality ; Humans ; Male ; Medical sciences ; Medical screening ; Middle Aged ; Mortality ; Predictive Value of Tests ; Pulse</subject><ispartof>The American journal of cardiology, 2002-04, Vol.89 (7), p.851-855</ispartof><rights>2002 Excerpta Medica Inc.</rights><rights>2002 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. Apr 1, 2002</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c387t-13a24ee87f8d44f8d06aa42d6ae2286abbb43716f625958bf8d52cbc4ee673ea3</citedby><cites>FETCH-LOGICAL-c387t-13a24ee87f8d44f8d06aa42d6ae2286abbb43716f625958bf8d52cbc4ee673ea3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914902021987$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13573111$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11909573$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bossone, Eduardo</creatorcontrib><creatorcontrib>Rampoldi, Vincenzo</creatorcontrib><creatorcontrib>Nienaber, Christoph A</creatorcontrib><creatorcontrib>Trimarchi, Santi</creatorcontrib><creatorcontrib>Ballotta, Andrea</creatorcontrib><creatorcontrib>Cooper, Jeanna V</creatorcontrib><creatorcontrib>Smith, Dean E</creatorcontrib><creatorcontrib>Eagle, Kim A</creatorcontrib><creatorcontrib>Mehta, Rajendra H</creatorcontrib><creatorcontrib>International Registry of Acute Aortic Dissection (IRAD) Investigators</creatorcontrib><title>Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Vascular compromise seen with pulse deficits is common in patients with type A dissection. However, patient characteristics and in-hospital outcomes associated with pulse deficits have not been evaluated. Accordingly, we studied 513 patients (mean age 62 ± 14 years, 65% men) with acute type A aortic dissection enrolled in the International Registry of Acute Aortic Dissection. Pulse deficits, defined as decreased or absent carotid or peripheral pulses as noted by clinicians and later confirmed by diagnostic imaging, at surgery or at autopsy were noted in 154 patients (30%). Age <70 years, male gender, neurologic deficit(s), altered mental status, and hypotension, shock, or tamponade on admission were all significantly higher in patients with than without pulse deficits. The etiology of aortic dissection, clinical symptoms, and imaging findings were similar in the 2 groups. In-hospital complications (hypotension, coma, renal failure, and limb ischemia) and mortality (41% vs 25%, p = 0.0002) were significantly higher in patients with pulse deficit. Cox proportional-hazards regression analysis identified pulse deficit as an independent predictor of 5-day in-hospital mortality (risk ratio 2.73, 95% confidence interval 1.7 to 4.4; p <0.0001). Further, overall mortality rates increased with an increasing number of pulse deficits (p for trend <0.0001). Pulse deficits are common findings in patients with type A aortic dissection and identify those at high risk of in-hospital adverse events. This simple clinical sign should direct physicians to consider a diagnosis of aortic dissection in patients with acute chest pain, and should help identify a subgroup of patients who would benefit from more aggressive strategies.</description><subject>Aged</subject><subject>Aneurysm, Dissecting - complications</subject><subject>Aneurysm, Dissecting - diagnosis</subject><subject>Aneurysm, Dissecting - mortality</subject><subject>Aneurysm, Dissecting - physiopathology</subject><subject>Aortic Aneurysm - complications</subject><subject>Aortic Aneurysm - diagnosis</subject><subject>Aortic Aneurysm - mortality</subject><subject>Aortic Aneurysm - physiopathology</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Chest Pain - etiology</subject><subject>Diagnosis, Differential</subject><subject>Diseases of the aorta</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medical screening</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Predictive Value of Tests</subject><subject>Pulse</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkcFq3DAQhkVJaLZJHiFFBArtwY1GsmX7FEJom0AghyZnIctjouC1XElu2UufvbPZJTn2okHM98-IT4ydgfgKAvTFTyGELFoo289CfhES2qao37EVNHVbQAvqgK1ekSP2IaVnugJU-j07AmhFW9Vqxf4-JhyWccKUeBj4vIwJeY-Ddz7zHPgcsfcucz8VTyHNPtuRu7CeR-9s9mFK3E49X4dIDZ83xPGZGjjlxP_4_MStWzLyvJmRX3FLnHe89ymh28ZP2OFgaeXpvh6zx-_fHq5virv7H7fXV3eFU02dC1BWlohNPTR9WdIhtLWl7LVFKRttu64rVQ160LJqq6YjopKuc5TRtUKrjtn5bu4cw68FUzbPYYkTrTRSCaWrptQEVTvIxZBSxMHM0a9t3BgQZivdvEg3W6OG6ot0U1Pu43740q2xf0vtLRPwaQ_Y5Ow4RDs5n944RRAAEHe545BU_PYYTXKk0tEXRPJl-uD_85R_QGegpA</recordid><startdate>20020401</startdate><enddate>20020401</enddate><creator>Bossone, Eduardo</creator><creator>Rampoldi, Vincenzo</creator><creator>Nienaber, Christoph A</creator><creator>Trimarchi, Santi</creator><creator>Ballotta, Andrea</creator><creator>Cooper, Jeanna V</creator><creator>Smith, Dean E</creator><creator>Eagle, Kim A</creator><creator>Mehta, Rajendra H</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope></search><sort><creationdate>20020401</creationdate><title>Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection</title><author>Bossone, Eduardo ; Rampoldi, Vincenzo ; Nienaber, Christoph A ; Trimarchi, Santi ; Ballotta, Andrea ; Cooper, Jeanna V ; Smith, Dean E ; Eagle, Kim A ; Mehta, Rajendra H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c387t-13a24ee87f8d44f8d06aa42d6ae2286abbb43716f625958bf8d52cbc4ee673ea3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Aged</topic><topic>Aneurysm, Dissecting - complications</topic><topic>Aneurysm, Dissecting - diagnosis</topic><topic>Aneurysm, Dissecting - mortality</topic><topic>Aneurysm, Dissecting - physiopathology</topic><topic>Aortic Aneurysm - complications</topic><topic>Aortic Aneurysm - diagnosis</topic><topic>Aortic Aneurysm - mortality</topic><topic>Aortic Aneurysm - physiopathology</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Chest Pain - etiology</topic><topic>Diagnosis, Differential</topic><topic>Diseases of the aorta</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medical screening</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Predictive Value of Tests</topic><topic>Pulse</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bossone, Eduardo</creatorcontrib><creatorcontrib>Rampoldi, Vincenzo</creatorcontrib><creatorcontrib>Nienaber, Christoph A</creatorcontrib><creatorcontrib>Trimarchi, Santi</creatorcontrib><creatorcontrib>Ballotta, Andrea</creatorcontrib><creatorcontrib>Cooper, Jeanna V</creatorcontrib><creatorcontrib>Smith, Dean E</creatorcontrib><creatorcontrib>Eagle, Kim A</creatorcontrib><creatorcontrib>Mehta, Rajendra H</creatorcontrib><creatorcontrib>International Registry of Acute Aortic Dissection (IRAD) Investigators</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bossone, Eduardo</au><au>Rampoldi, Vincenzo</au><au>Nienaber, Christoph A</au><au>Trimarchi, Santi</au><au>Ballotta, Andrea</au><au>Cooper, Jeanna V</au><au>Smith, Dean E</au><au>Eagle, Kim A</au><au>Mehta, Rajendra H</au><aucorp>International Registry of Acute Aortic Dissection (IRAD) Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2002-04-01</date><risdate>2002</risdate><volume>89</volume><issue>7</issue><spage>851</spage><epage>855</epage><pages>851-855</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Vascular compromise seen with pulse deficits is common in patients with type A dissection. However, patient characteristics and in-hospital outcomes associated with pulse deficits have not been evaluated. Accordingly, we studied 513 patients (mean age 62 ± 14 years, 65% men) with acute type A aortic dissection enrolled in the International Registry of Acute Aortic Dissection. Pulse deficits, defined as decreased or absent carotid or peripheral pulses as noted by clinicians and later confirmed by diagnostic imaging, at surgery or at autopsy were noted in 154 patients (30%). Age <70 years, male gender, neurologic deficit(s), altered mental status, and hypotension, shock, or tamponade on admission were all significantly higher in patients with than without pulse deficits. The etiology of aortic dissection, clinical symptoms, and imaging findings were similar in the 2 groups. In-hospital complications (hypotension, coma, renal failure, and limb ischemia) and mortality (41% vs 25%, p = 0.0002) were significantly higher in patients with pulse deficit. Cox proportional-hazards regression analysis identified pulse deficit as an independent predictor of 5-day in-hospital mortality (risk ratio 2.73, 95% confidence interval 1.7 to 4.4; p <0.0001). Further, overall mortality rates increased with an increasing number of pulse deficits (p for trend <0.0001). Pulse deficits are common findings in patients with type A aortic dissection and identify those at high risk of in-hospital adverse events. This simple clinical sign should direct physicians to consider a diagnosis of aortic dissection in patients with acute chest pain, and should help identify a subgroup of patients who would benefit from more aggressive strategies.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>11909573</pmid><doi>10.1016/S0002-9149(02)02198-7</doi><tpages>5</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9149 |
| ispartof | The American journal of cardiology, 2002-04, Vol.89 (7), p.851-855 |
| issn | 0002-9149 1879-1913 |
| language | eng |
| recordid | cdi_proquest_journals_230365846 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged Aneurysm, Dissecting - complications Aneurysm, Dissecting - diagnosis Aneurysm, Dissecting - mortality Aneurysm, Dissecting - physiopathology Aortic Aneurysm - complications Aortic Aneurysm - diagnosis Aortic Aneurysm - mortality Aortic Aneurysm - physiopathology Biological and medical sciences Blood and lymphatic vessels Cardiology Cardiology. Vascular system Chest Pain - etiology Diagnosis, Differential Diseases of the aorta Female Hospital Mortality Humans Male Medical sciences Medical screening Middle Aged Mortality Predictive Value of Tests Pulse |
| title | Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-25T07%3A05%3A23IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Usefulness%20of%20pulse%20deficit%20to%20predict%20in-hospital%20complications%20and%20mortality%20in%20patients%20with%20acute%20type%20A%20aortic%20dissection&rft.jtitle=The%20American%20journal%20of%20cardiology&rft.au=Bossone,%20Eduardo&rft.aucorp=International%20Registry%20of%20Acute%20Aortic%20Dissection%20(IRAD)%20Investigators&rft.date=2002-04-01&rft.volume=89&rft.issue=7&rft.spage=851&rft.epage=855&rft.pages=851-855&rft.issn=0002-9149&rft.eissn=1879-1913&rft.coden=AJCDAG&rft_id=info:doi/10.1016/S0002-9149(02)02198-7&rft_dat=%3Cproquest_cross%3E111740594%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=230365846&rft_id=info:pmid/11909573&rft_els_id=S0002914902021987&rfr_iscdi=true |