Nevin Manimala Statistics

Validation of the GERAADA Score to Predict 30-day Mortality in Acute Type A Aortic Dissection in a Single High-Volume Aortic Center

Eur J Cardiothorac Surg. 2023 Dec 18:ezad412. doi: 10.1093/ejcts/ezad412. Online ahead of print.


BACKGROUND: This study aimed to evaluate employing the German Registry of Acute Aortic Dissection Type A (GERAADA) score to predict 30-day mortality in an aortic center in the United States.

METHODS: Between January 2010 and June 2021, 689 consecutive patients underwent surgery for acute type A dissection at a single institution. Excluded were patients with missing clinical data (N = 4). The GERAADA risk score was retrospectively calculated via a web-based application. Model discrimination power was calculated with c-statistics from logistic regression and reported as the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals (CIs). The calibration was measured by calculating the observed versus estimated mortality (O/E) ratio. The Brier score was used for the overall model evaluation.

RESULTS: Included were 685 patients [mean age 60.6 years (SD: 13.5), 64.8% male] who underwent surgery for acute Type A aortic dissection. The 30-day mortality rate was 12.0%. The GERAADA score demonstrated very good discrimination power with an AUC of 0.762 (95% CI 0.703-0.821). The entire cohort’s O/E ratio was 0.543 (0.439-0.648), indicating an overestimation of the model-calculated risk. The Brier score was 0.010, thus revealing the model’s acceptable overall performance.

CONCLUSIONS: The GERAADA score is a practical and easily accessible tool for reliably estimating the 30-day mortality risk of patients undergoing surgery for acute Type A aortic dissection. This model may naturally overestimate risk in patients undergoing surgery in experienced aortic centers.

PMID:38109506 | DOI:10.1093/ejcts/ezad412

By Nevin Manimala

Portfolio Website for Nevin Manimala