Table_1_Association Between D-dimer and Early Adverse Events in Patients With Acute Type A Aortic Dissection Undergoing Arch Replacement and the Frozen Elephant Trunk Implantation: A Retrospective Cohort Study.DOCX

ObjectiveIn the present study, we investigated the associations between D-dimer levels at admission and early adverse events in patients with acute type A aortic dissection undergoing arch replacement and the frozen elephant trunk (FET).
MethodsWe retrospectively analyzed data of patients with acute type A aortic dissection undergoing aortic arch surgery and FET from July 2017 to December 2018 at Beijing Anzhen Hospital. D-dimer levels were evaluated within 24 h of admission. Multivariate Cox regression analysis was used to determine independent predictors of early postoperative adverse events.
ResultsA total of 347 patients were included in the study. The average age of the patients was 48.07 ± 10.56 years, with male predominance (79.25%). The incidence of 90-day postoperative adverse events was 18.7%, consisting of 14.7% mortality and 4.0% permanent neurological dysfunction (PND). The median D-dimer level was 1.95 ug/ml (interquartile range, 0.77–3.16 ug/ml). Multivariable Cox regression analysis revealed that D-dimer level was independently associated with 90-day postoperative adverse events after adjustment for confounding factors (hazard ratio = 1.19 per 10 ug/ml increase in D-dimer, 95% confidence interval: 1.01–1.41; P = 0.039). Kaplan–Meier analysis revealed that the highest tertile (median 6.27 ug/ml) had more 90-day postoperative adverse events compared with the median and lowest tertiles (P = 0.0014). Sub-analysis found that the association remained unchanged.
ConclusionIncreased D-dimer levels at admission were associated with 90-day postoperative adverse events in patients with acute type A aortic dissection undergoing arch replacement and FET. These results may help clinicians optimize the risk evaluation and perioperative clinical management to reduce early adverse events.
Key QuestionExplore the relationship between D-dimer and early outcomes in patients with aortic dissection with arch replacement.
Key FindingsIncreased D-dimer at admission was associated with adverse events in patients with aortic dissection with arch surgery.
Take-Home MessageThe high-risk patients deserve close medical monitoring.

目的 本研究旨在探讨接受主动脉弓置换术及冷冻象鼻术（frozen elephant trunk, FET）的急性A型主动脉夹层患者入院时的D-二聚体水平与术后早期不良事件的关联。
方法 回顾性分析2017年7月至2018年12月于北京安贞医院接受主动脉弓手术及冷冻象鼻术的急性A型主动脉夹层患者的临床资料。于患者入院24小时内检测其D-二聚体水平。采用多因素Cox回归分析确定术后早期不良事件的独立预测因素。
结果 本研究共纳入347例患者，患者平均年龄为48.07±10.56岁，男性占比79.25%。术后90天不良事件发生率为18.7%，其中死亡率14.7%，永久性神经功能障碍（permanent neurological dysfunction, PND）发生率4.0%。患者D-二聚体水平中位数为1.95 μg/ml（四分位数间距：0.77~3.16 μg/ml）。多因素Cox回归分析显示，在校正混杂因素后，D-二聚体水平与术后90天不良事件独立相关（每升高10 μg/ml，风险比为1.19，95%置信区间：1.01~1.41；P=0.039）。Kaplan–Meier分析显示，D-二聚体最高三分位组（中位数6.27 μg/ml）的术后90天不良事件发生率高于中、低三分位组（P=0.0014）。亚组分析显示该关联保持稳定。
结论 接受主动脉弓置换术及冷冻象鼻术的急性A型主动脉夹层患者，入院时D-二聚体水平升高与术后90天不良事件显著相关。本研究结果可为临床医师优化风险评估及围术期管理以降低早期不良事件提供参考。
核心问题 探讨接受主动脉弓置换术的主动脉夹层患者D-二聚体水平与早期预后的关联。
核心发现 急性A型主动脉夹层患者入院时D-二聚体水平升高与主动脉弓手术术后不良事件相关。
临床启示 高风险患者需接受严密的医学监测。