Observational study of mortality risk stratification by ischemic presentation in patients with acute type A aortic dissection: the Penn classification
Observational study of mortality risk stratification by ischemic presentation in patients with acute type A aortic dissection: the Penn classification
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DOI：
10.1038/ncpcardio1417
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发表时间：
2009-02-01
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影响因子：
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通讯作者：
Bavaria, Joseph E.
中科院分区：
文献类型：
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作者：
Augoustides, John G. T.;Geirsson, Arnar;Bavaria, Joseph E.
研究背景急性A型主动脉夹层是外科急症，手术死亡率高达25%。缺血是已知的死亡率预测因子。我们测试了一个分类系统的有效性，宾夕法尼亚州的分类，这是基于缺血模式在临床表现分层手术死亡风险和识别高风险组的患者进一步干预和study.Methods在这项前瞻性观察研究中，患者进行了标准的主动脉夹层修复协议在宾夕法尼亚大学，费城，PA，从1993年至2004年。患者分为无缺血、分支血管灌注不良伴局部器官缺血、全身缺血伴循环衰竭、伴或不伴心脏受累、局部和全身缺血相结合。平均年龄为61.6（+/- 14.8）岁，66.5%为男性。就诊时，57.9%的患者无缺血，17.6%的患者有局部缺血，15.4%的患者有全身缺血，9.0%的患者有局部和全身缺血。总体而言，28例（12.7%）患者在围手术期死亡。两组间全因死亡率差异显著（无缺血3.1%，局部缺血25.6%，全身缺血17.6%，合并缺血40.0%），无缺血组与任何缺血组相比，总死亡率差异为8.3倍（3.1% vs 25.8%，P = 0.0001）。缺血的介绍占85.7%的所有deaths.Conclusion急性A型主动脉夹层的Penn分类使分层的患者手术死亡风险。该系统需要进一步验证，但可能有助于分析这种疾病死亡率数据的新方法。
Background Acute type A aortic dissection is a surgical emergency, with an operative mortality as high as 25%. Ischemia is a known predictor of mortality. We tested the efficacy of a classification system-the Penn classification, which is based on ischemic pattern at clinical presentation to stratify operative mortality risk and identify high-risk groups of patients for further intervention and study.Methods In this prospective observational study, patients underwent a standard aortic dissection repair protocol at the University of Pennsylvania, Philadelphia, PA, from 1993 to 2004. Patients were classified as having no ischemia, branch vessel malperfusion with localized organ ischemia, generalized ischemia with circulatory collapse, with or without cardiac involvement, or a combination of localized and generalized ischemia.Results The cohort comprised 221 patients. The mean age was 61.6 (+/- 14.8) years and 66.5% were male. At presentation 57.9% of patients had no ischemia, 17.6% had localized ischemia, 15.4% had generalized ischemia, and 9.0% had both localized and generalized ischemia. Overall, 28 (12.7%) patients died during the perioperative period. All-cause mortality differed significantly between groups (no ischemia 3.1%, localized ischemia 25.6%, generalized ischemia 17.6%, combined ischemia 40.0%), yielding an overall 8.3-fold difference for no compared with any ischemia (3.1% versus 25.8%, P = 0.0001). Ischemic presentations together accounted for 85.7% of all deaths.Conclusion The Penn classification of acute type A aortic dissection enabled stratification of patients by operative mortality risk. The system requires further validation, but might facilitate new ways to analyze mortality data for this disorder.