Clinical Implications of Electrocardiograms for Patients With Type A Acute Aortic Dissection

• Published in: Circulation Journal Vol. 81; no. 9; pp. 1254 - 1260
• Main Authors: Kosuge, Masami, Kimura, Kazuo, Uchida, Keiji, Masuda, Munetaka, Tamura, Kouichi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25.08.2017
• Subjects: Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - epidemiology; Acute Coronary Syndrome - physiopathology; Aneurysm, Dissecting - diagnosis; Aneurysm, Dissecting - epidemiology; Aneurysm, Dissecting - physiopathology; Aortic dissection; ECG; Electrocardiography; Female; Humans; Male; Mortality; ST-segment; ECG; Aortic dissection; ST-segment; Mortality
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-17-0309

Type A acute aortic dissection (AAD) is a serious cardiovascular emergency requiring urgent surgery. Timely accurate diagnosis is essential, but often challenging, because of the wide spectrum of clinical presentations. In patients with type A AAD, chest pain is the most common symptom; furthermore, ischemic ST-T changes such as ST-segment elevation or depression or negative T waves are frequently observed on presentation ECG. These clinical presentations of type A AAD are difficult to differentiate from those of acute coronary syndrome (ACS), which could lead to delayed diagnosis and treatment of type A AAD or misdiagnosis of ACS followed by inappropriate treatment. Of note, ischemic ST-T changes have been shown to be associated with poor outcomes in patients with type A AAD. Because ECG is simple, inexpensive, noninvasive, readily available, and rapidly interpretable at the time of presentation, risk stratification based on ECG findings is considered very useful clinically. ECG findings of type A AAD thus have clinically important diagnostic, therapeutic, and prognostic implications; however, the relationships among these factors remain poorly understood. We review the prevalence of ECG abnormalities, clinical features associated with such changes, and the prognostic importance in patients with type A AAD.