Prognostic impact of shock in patients with type A acute aortic syndrome. Results of a nationwide multicenter study.

Objective To evaluate the clinical characteristics, imaging findings, treatment and prognosis of patients with type A acute aortic syndrome (AAS-A) presenting with shock. To assess the impact of surgery in this patient population. Methods The study included 521 patients with A-AAS enrolled in the Spanish Registry of Acute Aortic Syndrome (RESA-III) from January-2018 to December-2019. The RESA-III is a prospective, multicenter registry that contains AAS data from 30 tertiary-care hospitals. Patients were classified in two groups according to the clinical presentation with or without shock. Shock was defined as persistent systolic blood pressure <80mmHg despite adequate volume resuscitation. Results 97 (18.6%) patients with A-AAS presented with shock. Clinical presentation with syncope was much more common in the Shock-group (45.4% vs 10.1%, p=0.001). Patients in the Shock-group had more complications at diagnosis and before surgery: cardiac tamponade (36.2% vs 9%, p<0.001), acute renal failure (28.9% vs 18.2%, p=0.018) and need for orotracheal intubation (40% vs 9.1%, p<0.001). There were no significant differences in aortic regurgitation (51.6% vs 46.7%, p=0.396) between groups. In-hospital mortality was higher among patients with shock (48.5% vs 27.4%, p<0.001). Surgery was associated with a significant mortality reduction both in patients with and without shock. Surgery had an independent protective effect on mortality (OR 0.03, 95% CI (0.00-0.32)). Conclusions Patients with AAS-A admitted with shock have a heavily increased risk of mortality. Syncope and pericardial effusion at diagnosis are strongly associated with shock. Surgery was independently associated with a mortality reduction in patients with AAS-A and shock.