Effect of Blood Pressure Level at Admission on In-Hospital Case-Fatality Rate in Patients with Aortic Dissection

Objective: To observe the correlation between the blood pressure level at admission in patients with aortic dissection and the in-hospital case-fatality rate. Methods: : A retrospective analysis was carried out on the clinical data of 580 aortic dissection patients (198 cases of Stanford type A aortic dissection and 382 cases of Stanford type B aortic dissection) who were hospitalized in our hospital from 2011 to 2018. According to the level of blood pressure at admission, the patients were assigned into five groups: group A (90-119/60-79 mmHg, n=107), group B (120-139/80-90 mmHg, n=121), group C (140-159/90-99 mmHg, n=140), group D (160-179/100-109 mmHg, n=107) and group E (≥180 mmHg, n=105). The number of cases of different types of aortic dissections, treatment methods and number of deaths at discharge were recorded in each group. Results: : No statistically significant differences in the sex, and histories of smoking, drinking, hypertension and diabetes were observed among the five groups ( p >0.05). Group A exhibited higher proportions of patients with Stanford type A aortic dissection and Marfan syndrome, a younger mean age of patients, a lower heart rate of patients at admission and more cases of surgical treatment than the other groups ( p <0.01). The proportions of cases of pain at admission, Stanford type B aortic dissection and interventional therapy in groups D and E were higher than those in the other groups ( p <0.01). Of 580 inpatients, there were 87 (15%) cases of death, and the in-hospital case-fatality rate in group A was higher than that in the other groups ( p <0.01). Group E had a lower in-hospital case-fatality rate than groups A, B, C and D ( p <0.05), and the differences among the latter three groups were statistically significant ( p <0.05). Therefore, the in-hospital case-fatality rate declined with the increase in the level of blood pressure at admission. Conclusion: A lower blood pressure level (160/100 mmHg) at admission in patients with aortic dissection can predict the classification of aortic dissection to a certain extent. The patients with a higher blood pressure level have obvious symptoms at admission and receive prompt treatments, and among them, more patients suffer from Stanford type B aortic dissection and undergo interventional therapy, so the overall case-fatality rate can be decreased.