Interdisciplinary cardiovascular and thoracic surgery · 2025
Utility of GERAADA Score for Predicting Long-term Survival Following Surgical Repair of Aortic Dissection.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Pollari Francesco, Nardi Paolo, Mikus Elisa, Ferraro Francesco, Gemelli Marco, Franzese Ilaria, Chirichilli Ilaria, Romagnoni Claudia, Santarpino Giuseppe, Nicolardi Salvatore, Scrofani Roberto, Ranocchi Federico, Mazzaro Enzo, Gerosa Gino, Massetti Massimo, Savini Carlo, Ruvolo Giovanni, Di Marco Luca, D'Ecclesiis Oriana, Guagneli Emma, Duranti Giorgia, Parolari Alessandro, Barili Fabio, GIROC (Italian Research Group on Outcome in Cardiac Surgery)
Аннотация
OBJECTIVES: We aimed to assess the long-term survival following surgical repair because of acute type A aortic dissection (ATAAD) and the correlation with the preoperative GERAADA (German Registry for Acute Type A Aortic Dissection)-score value.
METHODS: We enrolled patients who underwent emergent aortic surgery because of ATAAD from 2010 to 2022 from 9 hospitals. Follow-up information was obtained by matching the clinical patient data with a national administrative database. Discrimination and calibration of GERAADA were tested at 1, 2, 5, and 10 years. The relationship between long-term outcome and score was also tested through time-to-event methods.
RESULTS: A total of 1110 patients were analysed: Median age was 67 years [IQR 57-75], and 30.8% of subjects were female. Median GERAADA score was 14.3% [10.2-22]. Mean length of follow-up was 4.19 years. The Kaplan-Meier estimates of survival at 5 and 10 years were, respectively, 62.5% ± 1.5%, and 48.5% ± 2.1%. Discrimination was poor but remained stable over the time (area under the curve [AUC] at 1-year follow-up: 0.66; 95% CI 0.63-0.70. AUC at 10-year follow-up: 0.64; 95% CI 0.61-0.68). Calibration plots showed underprediction until 50%-predicted probability and progressive overprediction afterward. There is a steep mortality in the first couple of months after surgery while afterward the mortality rate is constantly lower. GERAADA score was found to be a predictor of long-term mortality with a nonlinear association.
CONCLUSIONS: GERAADA score showed a poor performance in predicting long-term survival.
METHODS: We enrolled patients who underwent emergent aortic surgery because of ATAAD from 2010 to 2022 from 9 hospitals. Follow-up information was obtained by matching the clinical patient data with a national administrative database. Discrimination and calibration of GERAADA were tested at 1, 2, 5, and 10 years. The relationship between long-term outcome and score was also tested through time-to-event methods.
RESULTS: A total of 1110 patients were analysed: Median age was 67 years [IQR 57-75], and 30.8% of subjects were female. Median GERAADA score was 14.3% [10.2-22]. Mean length of follow-up was 4.19 years. The Kaplan-Meier estimates of survival at 5 and 10 years were, respectively, 62.5% ± 1.5%, and 48.5% ± 2.1%. Discrimination was poor but remained stable over the time (area under the curve [AUC] at 1-year follow-up: 0.66; 95% CI 0.63-0.70. AUC at 10-year follow-up: 0.64; 95% CI 0.61-0.68). Calibration plots showed underprediction until 50%-predicted probability and progressive overprediction afterward. There is a steep mortality in the first couple of months after surgery while afterward the mortality rate is constantly lower. GERAADA score was found to be a predictor of long-term mortality with a nonlinear association.
CONCLUSIONS: GERAADA score showed a poor performance in predicting long-term survival.