256-Slice Computed Tomography in the Diagnosis of Coronary Artery Disease in Patients Presenting With Aortic Dissection Between 2011 and 2014 and the Influence of Concomitant Coronary Artery Disease on in-Hospital Mortalit


Department of Cardiology, Rajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R.Iran.


Background: In recent years, noninvasive methods have replaced angiography in the diagnosis of aortic dissection and concomitant coronary artery disease (CAD). Computed tomography (CT) angiography allows the assessment of CAD in this setting. Methods: In this retrospective study, we investigated the incidence of CAD in patients presenting with type A or B aortic dissection between 2011 and 2014 as assessed by CT angiography and the influence of concomitant CAD and coronary artery bypass grafting (CABG) on the in-hospital outcomes of these patients. Results: Ninety-one patients (67% male) were included in this study. Thirty-five (38.5%) patients had concomitant CAD on their CT angiography, and coronary artery ectasia was observed in 17 (18.7%) patients. Sixty-seven (73.6%) patients underwent surgery for their aortic dissection. Concurrent CABG was performed in 22 (62.8%) patients, who had significant coronary stenosis on coronary CT angiography. Mortality was significantly higher in the patients who had concomitant CAD. (Sixty-seven percent of the patients with CAD died; P<0.001.) The total in-hospital mortality rate was 29.7% (n =27). Mortality was higher in the patients with more severe CAD in terms of 2- and 3-vessel diseases, and CABG was significantly associated with higher mortality. Conclusions: Nowadays, invasive coronary angiography is infrequently performed in acute type A aortic dissection due to delay in surgery and increase in the risk of rupture. Multi-slice coronary CT angiography is a good alternative modality for the diagnosis of aortic dissection and CAD simultaneously with acceptable accuracy.