〔Abstract〕 Objective In this study, we aimed to determine the risk factors of sudden death and computed tomography angiography (CTA) manifestations in patients with acute type A aortic dissection (ATAAD). Methods From January 2018 to December 2020, 96 patients admitted to hospital with acute chest pain with diagnosed ATAAD were retrospectively enrolled in our study. Patients were divided according to sudden death within 48 h of ATAAD onset, with 13 sudden death in the observation group, and 83 alive in the control group. Logistic regression were applied to analyse risk factors of sudden death in patients with ATAAD. Results Multivariate logistic regression indicated that severe occlusion of the true lumen, involvement of coronary arteries, and laceration far than iliac artery bifurcation were CTA associated risk factors of death in 48 h. Conclusion In ATAAD patients, CTA indicated severe occlusion of the true cavity, involvement of coronary arteries, and laceration far than iliac artery bifurcation were associated with a high risk of sudden death, which required emergency intervention and early surgical treatment.