AIM To investigate the relationship between postoperative blood pressure control level and in-hospital death in elderly patients with hypertension and Stanford type A aortic dissection (TAAD).
METHODS A retrospective analysis of 160 elderly patients with hypertension and ATAD admitted to our hospital from February 2020 to April 2022 was included in the training set. According to the postoperative in-hospital death, they were divided into death group (n=80) and survival group (n=80). The general data of the two groups were compared. The blood pressure levels of the two groups before and within 72 hours after operation were also compared and analyzed. Univariate and multivariate analyses were performed using the COX proportional hazard model to determine the risk factors for in-hospital death. Stepwise regression method was used to further screen the most important clinical factors associated with in-hospital death, and a nomogram prediction model was constructed and evaluated. The patients were divided into five quantile groups (Q1~Q5) according to the levels of systolic blood pressure (SBP) and mean arterial pressure (MAP) at 72 h after operation from low to high. The clinical data characteristics of the five groups were compared and the correlation between the levels of SBP and MAP at each time period after operation and the risk of in-hospital death was analyzed by multivariate logistic regression.
RESULTS Compared with the survival group, the death group had a higher proportion of patients with aortic valve regurgitation (P<0.05), abdominal vascular involvement (P<0.01), and abnormal aortic contour (P<0.01). The time from onset to visit (P<0.05) was longer, LVEF (P<0.01) levels were lower, and D-D (P<0.01) levels were higher, The decrease in SBP (P<0.01) levels within 72 hours after surgery and MAP (P<0.01) levels within 72 hours after surgery are both risk factors for hospital death in elderly hypertensive patients with TAAD. Stepwise regression analysis identified that SBP, MAP, LVEF, and D-D were the most associated with hospital mortality in patients. The constructed column chart prediction model has high discrimination. The consistency index (C index) of the column graph for the training set and validation set are 0.756 (95% CI: 0.744～0.760) and 0.743 (95% CI: 0.732～0.750), respectively. There was an independent correlation between the levels of SBP and MAP within 72 hours after surgery and the risk of hospital death (OR=0.56, 95% CI: 0.39～0.77, P<0.01) and (OR=0.55, 95% CI: 0.37～0.79, P<0.01), and there was a statistically significant difference in the trend test of SBP and MAP from low to high quintiles at each postoperative time period. Conclusion: As the levels of SBP and MAP decrease within 72 hours after surgery in elderly hypertensive patients with TAAD, the hospital mortality rate gradually increases. Therefore, attention should be paid to the changes in SBP and MAP levels 72 hours after surgery in elderly hypertensive patients with TAAD, which can effectively reduce hospital mortality.
CONCLUSION With the decrease of SBP and MAP levels within 72 hours after operation in elderly patients with hypertension and TAAD, the in-hospital mortality gradually increases. Therefore, attention should be paid to the changes of SBP and MAP levels in elderly patients with hypertension and TAAD at 72 h after operation, which can effectively reduce the in-hospital mortality.
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