Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

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Standard

Stroke in acute type A aortic dissection : the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD). / Chemtob, Raphaelle A; Simonsen, Simon Fuglsang; Geirsson, Arnar; Ahlsson, Anders; Olsson, Christian; Gunn, Jarmo; Ahmad, Khalil; Hansson, Emma C; Pan, Emily; Arnadottir, Linda O; Mennander, Ari; Nozohoor, Shahab; Wickbom, Anders; Zindovic, Igor; Pivodic, Aldina; Jeppsson, Anders; Hjortdal, Vibeke; Gudbjartsson, Tomas.

In: European Journal of Cardio-Thoracic Surgery, Vol. 58, No. 5, 2020, p. 1027-1034.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Harvard

Chemtob, RA, Simonsen, SF, Geirsson, A, Ahlsson, A, Olsson, C, Gunn, J, Ahmad, K, Hansson, EC, Pan, E, Arnadottir, LO, Mennander, A, Nozohoor, S, Wickbom, A, Zindovic, I, Pivodic, A, Jeppsson, A, Hjortdal, V & Gudbjartsson, T 2020, 'Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)', European Journal of Cardio-Thoracic Surgery, vol. 58, no. 5, pp. 1027-1034. https://doi.org/10.1093/ejcts/ezaa197

APA

Chemtob, R. A., Simonsen, S. F., Geirsson, A., Ahlsson, A., Olsson, C., Gunn, J., Ahmad, K., Hansson, E. C., Pan, E., Arnadottir, L. O., Mennander, A., Nozohoor, S., Wickbom, A., Zindovic, I., Pivodic, A., Jeppsson, A., Hjortdal, V., & Gudbjartsson, T. (2020). Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD). European Journal of Cardio-Thoracic Surgery, 58(5), 1027-1034. https://doi.org/10.1093/ejcts/ezaa197

CBE

Chemtob RA, Simonsen SF, Geirsson A, Ahlsson A, Olsson C, Gunn J, Ahmad K, Hansson EC, Pan E, Arnadottir LO, Mennander A, Nozohoor S, Wickbom A, Zindovic I, Pivodic A, Jeppsson A, Hjortdal V, Gudbjartsson T. 2020. Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD). European Journal of Cardio-Thoracic Surgery. 58(5):1027-1034. https://doi.org/10.1093/ejcts/ezaa197

MLA

Chemtob, Raphaelle A et al. "Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)". European Journal of Cardio-Thoracic Surgery. 2020, 58(5). 1027-1034. https://doi.org/10.1093/ejcts/ezaa197

Vancouver

Chemtob RA, Simonsen SF, Geirsson A, Ahlsson A, Olsson C, Gunn J et al. Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD). European Journal of Cardio-Thoracic Surgery. 2020;58(5):1027-1034. https://doi.org/10.1093/ejcts/ezaa197

Author

Chemtob, Raphaelle A ; Simonsen, Simon Fuglsang ; Geirsson, Arnar ; Ahlsson, Anders ; Olsson, Christian ; Gunn, Jarmo ; Ahmad, Khalil ; Hansson, Emma C ; Pan, Emily ; Arnadottir, Linda O ; Mennander, Ari ; Nozohoor, Shahab ; Wickbom, Anders ; Zindovic, Igor ; Pivodic, Aldina ; Jeppsson, Anders ; Hjortdal, Vibeke ; Gudbjartsson, Tomas. / Stroke in acute type A aortic dissection : the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD). In: European Journal of Cardio-Thoracic Surgery. 2020 ; Vol. 58, No. 5. pp. 1027-1034.

Bibtex

@article{647866ad7e0d450a934321a70c348806,
title = "Stroke in acute type A aortic dissection: the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)",
abstract = "OBJECTIVES: Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients.METHODS: The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014.RESULTS: Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P < 0.001), syncope (30.6% vs 17.6%, P < 0.001), cardiogenic shock (33.1% vs 20.7%, P < 0.001) and pericardial tamponade (25.9% vs 14.7%, P < 0.001) and more often underwent total aortic arch replacement (10.7% vs 4.7%, P = 0.016), compared to patients without stroke. In the 86 patients presenting with cerebral malperfusion, 38.4% developed stroke. Thirty-day and 5-year mortality in patients with and without stroke were 27.1% vs 13.6% and 42.9% vs 25.6%, respectively. Stroke was an independent predictor of early- [odds ratio 2.02, 95% confidence interval (CI) 1.34-3.05; P < 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27-2.23; P < 0.001).CONCLUSIONS: Stroke in ATAAD patients is associated with increased early- and midterm mortality. Preoperative cerebral malperfusion and impaired haemodynamics, as well as total aortic arch replacement, were more frequent among patients who developed stroke. Importantly, a large proportion of patients presenting with cerebral malperfusion did not develop a permanent stroke, indicating that signs of cerebral malperfusion should not be considered a contraindication for surgery.",
author = "Chemtob, {Raphaelle A} and Simonsen, {Simon Fuglsang} and Arnar Geirsson and Anders Ahlsson and Christian Olsson and Jarmo Gunn and Khalil Ahmad and Hansson, {Emma C} and Emily Pan and Arnadottir, {Linda O} and Ari Mennander and Shahab Nozohoor and Anders Wickbom and Igor Zindovic and Aldina Pivodic and Anders Jeppsson and Vibeke Hjortdal and Tomas Gudbjartsson",
note = "{\textcopyright} The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.",
year = "2020",
doi = "10.1093/ejcts/ezaa197",
language = "English",
volume = "58",
pages = "1027--1034",
journal = "European Journal of Cardio-Thoracic Surgery",
issn = "1010-7940",
publisher = "Oxford University Press",
number = "5",

}

RIS

TY - JOUR

T1 - Stroke in acute type A aortic dissection

T2 - the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

AU - Chemtob, Raphaelle A

AU - Simonsen, Simon Fuglsang

AU - Geirsson, Arnar

AU - Ahlsson, Anders

AU - Olsson, Christian

AU - Gunn, Jarmo

AU - Ahmad, Khalil

AU - Hansson, Emma C

AU - Pan, Emily

AU - Arnadottir, Linda O

AU - Mennander, Ari

AU - Nozohoor, Shahab

AU - Wickbom, Anders

AU - Zindovic, Igor

AU - Pivodic, Aldina

AU - Jeppsson, Anders

AU - Hjortdal, Vibeke

AU - Gudbjartsson, Tomas

N1 - © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

PY - 2020

Y1 - 2020

N2 - OBJECTIVES: Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients.METHODS: The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014.RESULTS: Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P < 0.001), syncope (30.6% vs 17.6%, P < 0.001), cardiogenic shock (33.1% vs 20.7%, P < 0.001) and pericardial tamponade (25.9% vs 14.7%, P < 0.001) and more often underwent total aortic arch replacement (10.7% vs 4.7%, P = 0.016), compared to patients without stroke. In the 86 patients presenting with cerebral malperfusion, 38.4% developed stroke. Thirty-day and 5-year mortality in patients with and without stroke were 27.1% vs 13.6% and 42.9% vs 25.6%, respectively. Stroke was an independent predictor of early- [odds ratio 2.02, 95% confidence interval (CI) 1.34-3.05; P < 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27-2.23; P < 0.001).CONCLUSIONS: Stroke in ATAAD patients is associated with increased early- and midterm mortality. Preoperative cerebral malperfusion and impaired haemodynamics, as well as total aortic arch replacement, were more frequent among patients who developed stroke. Importantly, a large proportion of patients presenting with cerebral malperfusion did not develop a permanent stroke, indicating that signs of cerebral malperfusion should not be considered a contraindication for surgery.

AB - OBJECTIVES: Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients.METHODS: The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014.RESULTS: Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P < 0.001), syncope (30.6% vs 17.6%, P < 0.001), cardiogenic shock (33.1% vs 20.7%, P < 0.001) and pericardial tamponade (25.9% vs 14.7%, P < 0.001) and more often underwent total aortic arch replacement (10.7% vs 4.7%, P = 0.016), compared to patients without stroke. In the 86 patients presenting with cerebral malperfusion, 38.4% developed stroke. Thirty-day and 5-year mortality in patients with and without stroke were 27.1% vs 13.6% and 42.9% vs 25.6%, respectively. Stroke was an independent predictor of early- [odds ratio 2.02, 95% confidence interval (CI) 1.34-3.05; P < 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27-2.23; P < 0.001).CONCLUSIONS: Stroke in ATAAD patients is associated with increased early- and midterm mortality. Preoperative cerebral malperfusion and impaired haemodynamics, as well as total aortic arch replacement, were more frequent among patients who developed stroke. Importantly, a large proportion of patients presenting with cerebral malperfusion did not develop a permanent stroke, indicating that signs of cerebral malperfusion should not be considered a contraindication for surgery.

U2 - 10.1093/ejcts/ezaa197

DO - 10.1093/ejcts/ezaa197

M3 - Journal article

C2 - 32688394

VL - 58

SP - 1027

EP - 1034

JO - European Journal of Cardio-Thoracic Surgery

JF - European Journal of Cardio-Thoracic Surgery

SN - 1010-7940

IS - 5

ER -