What is the clinical evidence from this study?

Study design: RCT. Population: Acute Type A Aortic Dissection (n=680). Intervention: Low heart rate target (55-65 bpm) vs. Standard heart rate target (75-85 bpm). Primary outcome: Rate of major adverse cardiovascular event within 30 days after surgery.

What does this research mean for the field?

The ESCORT trial will evaluate whether a low preoperative heart rate target (55-65 bpm) compared to a standard target (75-85 bpm) reduces 30-day major adverse cardiovascular events in patients with acute Type A aortic dissection. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The trial aims to determine the optimal preoperative heart rate target for patients with acute type A aortic dissection to improve clinical outcomes.

April 12, 2026Open Access

Efficacy and Safety of preoperative Controlling Heart Rate in Patients with Acute Type A Aortic Dissection (ESCORT): protocol for a randomised controlled trial

Key Result

The ESCORT trial will randomize 680 patients with acute Type A aortic dissection to a low (55-65 bpm) or standard (75-85 bpm) preoperative heart rate target to assess 30-day MACE.

Key Points

The trial aims to determine the optimal preoperative heart rate target for patients with acute type A aortic dissection to improve clinical outcomes.
Multicentre, single-blind randomised controlled trial.
Involves 680 adults diagnosed with acute Stanford Type A aortic dissection.
Participants are randomised into two groups: low heart rate (55–65 bpm) and standard heart rate (75–85 bpm).
Esmolol is the primary medication used to achieve target heart rates.
Primary outcome is the rate of major adverse cardiovascular events within 30 days post-surgery.
The study will provide evidence on the efficacy and safety of preoperative heart rate management.
Findings may encourage redesigning clinical guidelines for heart rate targets in high-risk aortic dissection patients.
Potential to influence standard care protocols based on study outcomes.

Study Design

Type

RCT (n=680)

Blinding

Single-blind

Randomization

Randomised into two groups

Multicenter

Yes

Structured PICO

Does a preoperative low heart rate target (55-65 bpm) reduce major adverse cardiovascular events within 30 days after surgery in adult patients with acute Type A aortic dissection compared to a standard target (75-85 bpm)?

Population

680 adult patients diagnosed with acute (Stanford Type A) aortic dissection, scheduled for aortic arch prosthetic vascular replacement and elephant trunk stent implantation surgery.

Intervention

Preoperative low heart rate target (55–65 beats per minute) achieved via protocol-directed medication (primarily esmolol).

Comparator

Preoperative standard heart rate target (75–85 beats per minute) achieved via protocol-directed medication.

Outcome

Rate of major adverse cardiovascular event within 30 days after surgery.composite

The ESCORT trial protocol outlines a randomized study to determine if a strict preoperative heart rate target of 55-65 bpm improves 30-day outcomes compared to 75-85 bpm in patients with acute Type A aortic dissection.

Abstract

Introduction Aortic dissection (AD) is a life-threatening cardiovascular emergency with a high mortality rate, and acute Stanford Type A AD is the most dangerous form, often requiring surgical intervention. Factors contributing to the progression of AD include increased heart rate, blood pressure and the rate of ventricular contraction (dP/dt). While heart rate control is a cornerstone of preoperative management for AD per existing guidelines, the recommended target (eg, ≤60 bpm in American Heart Association 2010) is consensus-driven (Level C) and thus not grounded in high-level evidence. The ESCORT ( E fficacy and S afety of preoperative Co ntrolling heart R ate in patients with acute T ype A aortic dissection) trial is designed to address this critical gap by providing high-level evidence from a randomised controlled trial to define the optimal preoperative heart rate target. Methods and analysis The study is a multicentre, single-blind, RCT involving adult patients diagnosed with acute (Stanford Type A) AD, scheduled for aortic arch prosthetic vascular replacement and elephant trunk stent implantation surgery. 680 patients will be randomised into two groups: low heart rate target group (55–65 beats per minute) and standard heart rate target group (75–85 beats per minute). The intervention involves protocol-directed medication to achieve the target heart rates, with esmolol as the primary recommended agent. The primary outcome measure is the rate of major adverse cardiovascular event within 30 days after surgery, and secondary outcomes include various clinical, economic and biochemical measures. Discussion The ESCORT study is the large-scale RCT to investigate the optimal preoperative heart rate control in patients with acute type A AD. The results of this study have the potential to fill the evidence gap in current clinical guidelines and provide evidence-based support for clinical management. The findings may influence the standard of care by either endorsing lower heart rate targets or providing alternative guidance for managing heart rate in this high-risk patient population. The study’s results will be disseminated through publications and presentations at both national and international conferences, ensuring that the results are accessible to the medical community and relevant patient organisations. Ethics and dissemination This study, including the study protocol (version 1.3, 3 December 2022), was approved by the Ethics Committee of Fuwai Hospital, CAMS and PUMC (approval number: 2022-1886). Additional approvals were obtained from the ethics committees of participating subcentres (approval numbers are listed in the main text). The findings will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences. Trial registration number ChiCTR2300067811.