Comparison of 4 mortality scores for surgical repair of type A aortic dissection: a multicentre external validation

Francesco Pollari, Paolo Nardi, Elisa Mikus, Francesco Ferraro, Marco Gemelli, Ilaria Franzese, Ilaria Chirichilli, Claudia Romagnoni, Giuseppe Santarpino, Salvatore Nicolardi, Roberto Scrofani, Francesco Musumeci, Enzo Mazzaro, Gino Gerosa, Massimo Massetti, Carlo Savini, Giovanni Ruvolo, Michele Di Mauro, Luca Di Marco, Fabio BariliAlessandro Parolari, Theodor Fischlein

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

OBJECTIVES: In the last decades, 4 different scores for the prediction of mortality following surgery for type A acute aortic dissection (TAAD) were proposed. We aimed to validate these scores in a large external multicentre cohort. METHODS: We retrospectively analysed patients who underwent surgery for TAAD between 2000 and 2020. Patients were enrolled from 10 centres from 2 European countries. Outcomes were the early (30-day and/or in-hospital) and 1-year mortality. Discrimination, calibration and observed/expected (O/E) ratio were evaluated. RESULTS: A total of 1895 patients (31.7% females, mean age 63.72 ± 12.8 years) were included in the study. Thirty-day mortality and in-hospital mortality were 21.7% (n = 412) and 22.5% (n = 427) respectively. The German Registry of Acute Aortic Dissection Type A (GERAADA) score shows to have the best discrimination [area under the curve (AUC) 0.671 and 0.672] in predicting as well the early and the 1-year mortality, followed by the International Registry of Acute Aortic Dissection (IRAD) model 1 (AUC 0.658 and 0.672), the Centofanti (AUC 0.645 and 0.66) and the UK aortic score (AUC 0.549 and 0.563). According to Hosmer-Lemeshow and Brier tests, the IRAD model I and GERAADA, respectively, were well calibrated for the early mortality, while the GERAADA and Centofanti for the 1-year mortality. The O/E analysis showed a marked underestimation for patients labelled as low-risk for UK aortic score and IRAD model I for both outcomes. CONCLUSIONS: The GERAADA score showed the best performance in comparison with other scores. However, none of them achieved together a fair discrimination and a good calibration for predicting either the early or the 1-year mortality.
Lingua originaleEnglish
pagine (da-a)N/A-N/A
RivistaEuropean Journal of Cardio-thoracic Surgery
Volume65
DOI
Stato di pubblicazionePubblicato - 2024

Keywords

  • Aortic dissection
  • Scores
  • Outcomes
  • Long-term survival

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