Predicting Late Adverse Events in Uncomplicated Stanford Type B Aortic Dissection: Results From the ROADMAP Validation Study.
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Fleischmann Dominik, Mastrodicasa Domenico, Willemink Martin J, Turner Valery L, Hinostroza Virginia, Burris Nicholas S, Yang Bo, Hanneman Kate, Ouzounian Maral, Ocazionez Trujillo Daniel, Afifi Rana O, Estrera Anthony L, Lacomis Joan M, Sultan Ibrahim, Gleason Thomas G, Pacini Davide, Folesani Gianluca, Lovato Luigi, Stillman Arthur E, De Cecco Carlo N, Chen Edward P, Hinzpeter Ricarda, Alkadhi Hatem, Hedgire Sandeep, Sundt Thoralf M, van Kuijk Sander M J, Schurink Geert Willem H, Chin Anne S, Codari Marina, Sailer Anna M, Mistelbauer Gabriel, Madani Mohammad H, Bäumler Kathrin, Shen Jody, Lai Kendrick M, Fischbein Michael P, Miller D Craig
Аннотация
METHODS: We assembled a retrospective multicenter cohort (ROADMAP [Registry of Aortic Diseases to Model Adverse Events and Progression]) of 401 patients with uncomplicated Stanford type B aortic dissection presenting to 1 of 8 aortic centers between 2001 and 2013, followed until 2020. LAEs were defined as fatal or nonfatal aortic rupture, new refractory hypertension or pain, organ or limb ischemia, aortic aneurysm formation (≥6 cm), or rapid growth (≥1 cm per year). We applied the original model parameters to the validation cohort and examined the effect on risk categorization using LAE end points.
RESULTS: One hundred and seventy-six patients (44%) with incomplete imaging or clinical data were excluded. Of 225 patients in the final cohort, 90 (40%) developed LAEs, predominantly driven by aneurysm formation. Baseline maximum aortic diameter was significantly larger in patients with (42.6 [95% CI, 39.1-45.8] mm) compared with patients without LAEs (39.9 [95% CI, 36.3-44.2] mm; P=0.001). A multivariable Cox regression model indicated that only maximum diameter was associated with LAEs (hazard ratio, 1.07 [95% CI, 1.03-1.11] per mm; P<0.001), while the other parameters were not (P>0.05). Applying the original prediction model to the validation cohort resulted in a poor 5-year sensitivity (38%) and specificity (69%).
CONCLUSIONS: A clinical and imaging-based prediction model performed poorly in the ROADMAP cohort. Maximum aortic diameter remains the strongest predictor of LAEs in uncomplicated Stanford type B aortic dissection.