TY - JOUR
T1 - Comparison of 4 mortality scores for surgical repair of type A aortic dissection
T2 - a multicentre external validation
AU - Pollari, Francesco
AU - Nardi, Paolo
AU - Mikus, Elisa
AU - Ferraro, Francesco
AU - Gemelli, Marco
AU - Franzese, Ilaria
AU - Chirichilli, Ilaria
AU - Romagnoni, Claudia
AU - Santarpino, Giuseppe
AU - Nicolardi, Salvatore
AU - Scrofani, Roberto
AU - Musumeci, Francesco
AU - Mazzaro, Enzo
AU - Gerosa, Gino
AU - Massetti, Massimo
AU - Savini, Carlo
AU - Ruvolo, Giovanni
AU - Di Mauro, Michele
AU - Di Marco, Luca
AU - Barili, Fabio
AU - Parolari, Alessandro
AU - Fischlein, Theodor
AU - Italian Group of Research for Outcome in Cardiac Surgery (GIROC)
PY - 2024/2/1
Y1 - 2024/2/1
N2 - OBJECTIVES: In last decades, 4 different scores for 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 analyzed patients who underwent surgery for TAAD between 2000 and 2020. Patients were enrolled from 10 centers from 2 European countries. Outcomes were the early (30-days and/or in-hospital), and 1-year mortality. Discrimination, calibration and observed/expected (O/E) ratio were evaluated. RESULTS: 1895 patients (31.7% females, mean age 63.72?±?12.8?years) were included in the study. 30-days and in-hospital mortality were 21.7% (n?=?412) and 22.5% (n?=?427) respectively. The GERAADA score shows to have the best discrimination (AUC 0.671 and 0.672) in predicting as well the early and the 1-year mortality, followed by the 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.
AB - OBJECTIVES: In last decades, 4 different scores for 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 analyzed patients who underwent surgery for TAAD between 2000 and 2020. Patients were enrolled from 10 centers from 2 European countries. Outcomes were the early (30-days and/or in-hospital), and 1-year mortality. Discrimination, calibration and observed/expected (O/E) ratio were evaluated. RESULTS: 1895 patients (31.7% females, mean age 63.72?±?12.8?years) were included in the study. 30-days and in-hospital mortality were 21.7% (n?=?412) and 22.5% (n?=?427) respectively. The GERAADA score shows to have the best discrimination (AUC 0.671 and 0.672) in predicting as well the early and the 1-year mortality, followed by the 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.
KW - aortic dissection
KW - long-term survival
KW - outcomes
KW - scores
U2 - 10.1093/ejcts/ezae005
DO - 10.1093/ejcts/ezae005
M3 - Article
SN - 1010-7940
VL - 65
JO - European Journal of Cardio-Thoracic Surgery
JF - European Journal of Cardio-Thoracic Surgery
IS - 2
M1 - ezae005
ER -