Impact of coronary artery involvement on mortality in patients with acute type A aortic dissection: results from a large-scale cohort study

Understanding the type and extent of coronary artery involvement in patients with acute type A aortic dissection (ATAAD) is vital for surgical planning. The Neri classification has been proposed as a guide for surgical strategies, however, its prognostic impact on postoperative mortality rates remains understudied in large-scale cohorts.

We reviewed 600 ATAAD patients who underwent surgery and coronary computed tomography angiography from 2016 to 2020 at Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Patients were classified based on the Neri classification system: no coronary artery involvement, type A (ostial involvement), type B (dissection in coronary body), and type C (circumferential detachment or complete avulsion). The primary endpoint was 30-day mortality.

Overall, 28.3% of the patients had coronary artery involvement, with Neri type A, Neri type B, and Neri type C accounting for 13.3%, 11.2%, and 3.8%, respectively. The right coronary artery was more frequently involved (25.3%) than the left coronary artery (8.0%). In the unadjusted analysis, patients with coronary artery involvement exhibited a numerically higher 30-day mortality compared to those without (5.3% vs. 2.3%) (OR = 2.35, 95% CI: 0.94–5.88, P = 0.07), though this difference did not reach statistical significance. However, multivariable adjustment revealed significant association (adjusted OR = 3.71, 95% CI: 1.05–13.13, P = 0.04). Interestingly, after additional adjustment for coronary artery bypass grafting, the impact of coronary artery involvement on 30-day mortality no longer remained statistically significant (adjusted OR = 3.13, 95% CI: 0.85–11.58, P = 0.09). The 1-year mortality was higher in those with coronary artery involvement, but this significant association disappeared after adjusting for potential confounding variables. Furthermore, no significant difference in 30-day and 1-year mortality were observed among patients with different Neri classifications.

In patients with ATAAD who undergo surgery, the presence of coronary artery involvement is significantly associated with an increased risk of 30-day mortality. Proactive coronary artery bypass grafting may potentially mitigate the adverse impact of coronary artery involvement on 30-day mortality.