Admission pulse pressure and in-hospital mortality in type A acute aortic dissection: result from a Chinese study in stable patients on admission.

Objectives: In recent years, several epidemiologic studies have shown that pulse pressure (PP) is a powerful predictor of mortality from many cardiovascular diseases. However, few studies have reported the association between PP and adverse events during hospitalization in patients with type A acute aortic dissection (TAAAD). The aim of this study was to evaluate the relationship between admission PP and in-hospital all-cause mortality, in patients with TAAAD of relatively stable patients.

Methods: Patients with TAAAD of relatively stable patients admitted from January 2015 to December 2021 were included and divided into four groups according to the PP values measured at the time of admission: reduced group (PP ≤ 40 mmHg), normal group (40 < PP ≤ 56 mmHg), mildly elevated group (56 < PP ≤ 75 mmHg), and significantly elevated group (PP > 75 mmHg). A multivariate binary logistic regression model was constructed, plotted using nomogram and evaluated with ROC curve.

Results: Admission PP and in-hospital all-cause mortality showed a "J-curve" correlation and in-hospital all-cause mortality was significantly higher in the significantly elevated group and reduced group (P = 0.002), respectively. Multivariate binary logistic regression analysis showed that significantly elevated PP (PP > 75 mmHg) (P < 0.001) and reduced PP (P = 0.043), D-dimer (P < 0.001), ascending aortic diameter (P = 0.037), Abdominal visceral vessels involved (P = 0.017), and coronary atherosclerosis (P = 0.003) and emergent surgery (P < 0.001) were independent predictive factors for in-hospital all-cause mortality. The AUC of ROC plotted was 0.827 (95% CI 0.774-0.880).

Conclusions: Our findings demonstrated a "J-curve" association of admission PP with in-hospital all-cause mortality in TAAAD. Significantly elevated and reduced admission PP, D-dimer, ascending aortic diameter and coronary atherosclerosis were independent risk factors for in-hospital all-cause mortality in patients with TAAAD, and emergent surgery was a protective factor.