Timing of Recognition of Type A Acute Aortic Dissection in Acute Myocardial Infarction

Type A acute aortic dissection (AAD) is a life-threatening disease, particularly when complicated by coronary artery involvement. Coronary malperfusion by aortic dissection extended into coronary arteries leads to acute myocardial infarction (MI) and subsequent poor prognosis. 1 Hashimoto O Saito Y Nakayama T Okino S Sakai Y Nakamura Y Fukuzawa S Himi T Ishibashi I Kobayashi Y. Prognostic impact of branch vessel involvement on computed tomography versus clinical presentation of malperfusion in patients with type A acute aortic dissection. Am J Cardiol. 2021; 152: 158-163 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Because AAD and acute MI mimic in their clinical presentation, cardiac catheterization is sometimes performed in patients with AAD based on a misdiagnosis of acute coronary syndrome (ACS) in real-world practice, 2 Peng H Liu W Jian KT Xia Y Liu JS Sun LZ Mei YQ. Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study. BMC Cardiovasc Disord. 2022; 22: 383 Crossref PubMed Scopus (1) Google Scholar ,3 Ramanath VS Eagle KA Nienaber CA Isselbacher EM Froehlich JB Montgomery DG Cooper JV Gu X Evangelista A Voehringer M Beckman J Myrmel T Pape L Pyeritz RE Hirsch AT Gilon D Bossone E. The role of preoperative coronary angiography in the setting of type A acute aortic dissection: insights from the International Registry of Acute Aortic Dissection. Am Heart J. 2011; 161: 790-796.e1 Crossref PubMed Scopus (20) Google Scholar whereas our previous investigations indicated that percutaneous coronary intervention (PCI) as a bridge to surgery may improve survival in patients with type A AAD and coronary involvement. 4 Hashimoto O, Saito Y, Sasaki H, Yumoto K, Oshima S, Tobaru T, Kanda J, Sakai Y, Yasuda S, Angina Pectoris-Myocardial Infarction Multicenter Investigators. Treatment strategies and in-hospital mortality in patients with type A acute aortic dissection and coronary artery involvement [published online March 29, 2022]. J Thorac Cardiovasc Surg. https://doi.org/10.1016/j.jtcvs.2022.03.016. Google Scholar , 5 Saito Y Hashimoto O Nakayama T Sasaki H Yumoto K Oshima S Tobaru T Kushida S Kanda J Sakai Y Okino S Fukuzawa S Abiko A Itoh T Nakamura Y Nakashima T Yasuda S Goto K Takebayashi H Oshitomi T Sakamoto T Kojima S Otsuka Y Himi T Inagaki Y Yamaguchi J Hagiya K Nanasato M Kobayashi Y. Right versus left coronary artery involvement in patients with type A acute aortic dissection. Int J Cardiol. 2023; 371: 49-53 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 6 Ichihara S Saito Y Hashimoto O Sasaki H Yumoto K Oshima S Tobaru T Kanda J Sakai Y Yasuda S. Timing of myocardial infarction diagnosis in type A acute aortic dissection and coronary artery involvement. JACC Asia. 2023; 3: 531-533 Crossref PubMed Scopus (1) Google Scholar In this context, however, data are limited. Thus, we evaluated the characteristics and prognostic impact of the timing of recognition of type A AAD in patients with acute MI.