Diagnosis, management and mortality in acute aortic syndrome: results of the Spanish Registry of Acute Aortic Syndrome (RESA-II).

BACKGROUND: Recent advances in the diagnosis and treatment of acute aortic syndrome should improve the outcome of this disease. The Spanish Registry of Acute Aortic Syndrome aimed to assess current results in acute aortic syndrome management in a wide cohort of hospitals in the same geographical area. METHODS: From January 2012 to January 2014, 26 tertiary hospitals included 629 consecutive patients with acute aortic syndrome: 73% men, mean age 64.7±14 years (range 22-92), 443 type A (70.4%) and 186 type B (29.6%). RESULTS: Time elapsed between symptom onset and diagnosis was <12 hours in 70.7% of cases and <24 hours in 84.0% (median 5 hours; 25th-75th percentiles, 2.7-15.5 hours). Computed tomography was the first diagnostic technique in 78% of patients and transthoracic echocardiography in 15%. Surgical treatment was indicated in 78.3% of type A acute aortic syndrome. The interval between diagnosis and surgery was 4.8 hours (quartile 1-3, 2.5-11.4 hours). Among the patients with type B acute aortic syndrome, treatment was medical in 116 cases (62.4%), endovascular in 61 (32.8%) and surgical in nine (4.8%). Type A mortality during hospitalisation was 25.1% in patients treated surgically and 68% in those treated medically. Mortality in type B was 13.8% in those with medical treatment, 18.0% with endovascular therapy and 33.0% with surgical treatment. CONCLUSION: Improvements in the diagnosis and treatment of acute aortic syndrome have not resulted in a significant reduction in hospital mortality. The results of this study reflect more overall and less selected information on acute aortic syndrome management and the need for sustained advances in the therapeutic strategy of acute aortic syndrome.

Fístula coronaria gigante entre el tronco coronario izquierdo y vena cava superior complicada de disección coronaria / Giant coronary artery fistula between the left main coronary artery and the superior vena cava complicated by coronary artery dissection

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Spanish Acute Aortic Syndrome Study (RESA). Better diagnosis is not reflected in reduced mortality.

INTRODUCTION AND OBJECTIVES: Because acute aortic syndrome (AAS) is associated with high mortality, early diagnosis and treatment are vital. The aim of the Spanish Acute Aortic Syndrome Study (RESA) was to investigate the effectiveness of current treatment of AAS in a broad range of tertiary care hospitals in Spain. METHODS: Between January 2005 and December 2007, 24 tertiary care hospitals reported data on 519 patients with AAS (78% male, mean age 61 +/- 13 years, range 20-92 years): 357 had type-A AAS and 162 had type B. RESULTS: The time delay between symptom onset and diagnosis was <24 hours in 67% of cases and >72 hours in 11%. Some 80% of patients with type-A AAS were treated surgically. The interval between diagnosis and surgery was <24 hours in 90% of cases. In patients with type-B AAS, 34% received invasive treatment: 11% had surgery and 23% underwent endovascular procedures. Mortality during hospitalization in patients with type-A disease was 33% in those treated surgically and 71% in those treated medically. Mortality in patients with type-B disease was 17% with medical treatment, 27% with endovascular treatment and 50% with surgical treatment. CONCLUSIONS: Despite significant advances in the diagnosis of AAS, in-hospital mortality remains high. The findings of this study are representative of a broad range of unselected patients undergoing treatment for the disease and support the need for continuing improvements in therapeutic approaches to AAS.

[Preoperative risk evaluation in beating-heart coronary artery bypass surgery]. / Evaluación preoperatoria del riesgo en la cirugía coronaria sin circulación extracorpórea.

INTRODUCTION AND OBJECTIVES: Operative risk stratification scales for use in cardiac surgery have been developed for patients who undergo procedures using extracorporeal circulation. The aims of the present study were to investigate the use of six preoperative risk stratification scales in patients undergoing beating-heart surgery and to identify risk factors for major complications and mortality in our group of patients who underwent revascularization using this approach. PATIENTS AND METHOD: Between January 1997 and December 2002, we performed 762 coronary artery bypass operations on the beating heart; 61 patients suffered major complications (8%) and 25 died (3.3%). Risk factors for major complications and death were identified using logistic regression analysis of prospectively collected data. The following risk scores were calculated for each patient: Parsonnet 95, Parsonnet 97, Euroscore, Cleveland, Ontario, and French. Receiver operating characteristic curves were used to compare the ability of each scale to predict mortality and major complications. RESULTS: In our patient group, the preoperative variables associated with increased risk were: need for cardiopulmonary resuscitation, renal dysfunction, peripheral vasculopathy, and the presence of severe left main coronary artery disease, three-vessel disease, or an impaired ejection fraction. CONCLUSIONS: Mortality and major complications were best predicted by the Parsonnet 95 and Euroscore scales.

Evaluación preoperatoria del riesgo en la cirugía coronaria sin circulación extracorpórea / Preoperative risk evaluation in beating-heart coronary artery bypass surgery

Introducción y objetivos. Los modelos de estratificación del riesgo quirúrgico en cirugía cardíaca han sido elaborados a partir de pacientes intervenidos con circulación extracorpórea. El objetivo del presente estudio es valorar cómo se comportan 6 modelos de riesgo preoperatorio en pacientes intervenidos sin circulación extracorpórea, así como conocer cuáles son los factores de riesgo predictores de complicaciones mayores y mortalidad en nuestros pacientes revascularizados mediante dicha técnica.Pacientes y método. Entre enero de 1997 y diciembre de 2002 se realizó cirugía de revascularización miocárdica sin el uso de circulación extracorpórea en un total de 762 pacientes consecutivos; de ellos, 61 (8%) presentaron complicaciones mayores y 25 (3,3%) murieron. A partir de variables recogidas de forma prospectiva, se calcularon mediante un análisis de regresión logística los factores predictores para complicaciones mayores y mortalidad. En cada uno de los pacientes se calcularon las escalas de riesgo Parsonnet 95, Parsonnet 97, Euroscore, Cleveland, Ontario y Francesa. Mediante curvas ROC se comparó la capacidad de cada una de las escalas para predecir la mortalidad y la presencia de complicaciones mayores.Resultados. En nuestra serie, las variables preoperatorias que aumentan significativamente el riesgo fueron: la resucitación cardiopulmonar, la presencia de insuficiencia renal, la arteriopatía periférica, la presencia de enfermedad coronaria severa de tronco izquierdo en más de 3 vasos y la fracción de eyección deprimida.Conclusiones. Las escalas de riesgo que mejor predicen la mortalidad y la presencia de complicaciones mayores fueron Parsonnet 95 y Euroscore

Introduction and objectives. Operative risk stratification scales for use in cardiac surgery have been developed for patients who undergo procedures using extracorporeal circulation. The aims of the present study were to investigate the use of six preoperative risk stratification scales in patients undergoing beating-heart surgery and to identify risk factors for major complications and mortality in our group of patients who underwent revascularization using this approach.Patients and method. Between January 1997 and December 2002, we performed 762 coronary artery bypass operations on the beating heart; 61 patients suffered major complications (8%) and 25 died (3.3%). Risk factors for major complications and death were identified using logistic regression analysis of prospectively collected data. The following risk scores were calculated for each patient: Parsonnet 95, Parsonnet 97, Euroscore, Cleveland, Ontario, and French. Receiver operating characteristic curves were used to compare the ability of each scale to predict mortality and major complications.Results. In our patient group, the preoperative variables associated with increased risk were: need for cardiopulmonary resuscitation, renal dysfunction, peripheral vasculopathy, and the presence of severe left main coronary artery disease, three-vessel disease, or an impaired ejection fraction.Conclusions. Mortality and major complications were best predicted by the Parsonnet 95 and Euroscore scales

Evaluación preoperatoria del riesgo en la cirugía coronaria sin circulación extracorpórea / Preoperative assessment of risks: coronary bypass surgery

Los modelos de estratificación del riesgo quirúrgico en cirugía cardiaca han sido elaborados a partir de pacientes intervenidos con circulación extracorpórea. El objetivo del presente estudio es valorar como se comportan 6 modelos de riesgo preoperatorio en pacientes intervenidos sin circulación extracorpórea, así como conocer cuáles son los factores de riesgo predictores de complicaciones mayores y mortalidad en nuestros pacientes revascularizados mediante dicha técnica. Entre nero de 1997 y diciembre de 2002 se realizó cirugía de revascularización miocárdica sin el uso de circulación estracorpórea en un total de 762 pacientes consecutivos; de ellos, 61 (8 por ciento)presentaron complicaciones mayores y 25 (3,3 por ciento) murieron. A partir de variables recogidas de forma prospectiva, se calcularon mediante un análisis de regresión logística los factores predictores para complicaciones mayores y mortalidad. En cada uno de los pacientes se calcularon las escalas de riesgo Parsonnet 97, Euroscore, Cleveland, Ontario y Francesa. Mediante curvas ROC se comparó la capacidad de cada una de las escalas para predecir la mortalidad y la presencia de complicaciones mayores. En nuestra serie, las variables preoperatorias que aumentan significativamente el riesgo fueron:reanimación cardiopulmonar, la presencia de insuficiencia renal, la arteriopatía periférica, la presencia de enfermedad coronaria severa de tronco izquierdo en más de 3 vasos y la fracción de eyección deprimida. Las escalas de riesgo que mejor predicen la mortalidad y la presencia de complicaciones mayores fueron Parsonnet 95 y Euroscore(AU)