Journal of the American Heart Association · 2025
Validation of the GERAADA Score for Predicting 30-Day Mortality Rate in Acute Type A Aortic Dissection: A Single-Center Study in China.
СтатьяВалидационное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Lin Xin-Fan, Gao Hang-Qi, Wu Qing-Song, Xie Yu-Ling, Chen Liang-Wan, Xie Lin-Feng
Аннотация
BACKGROUND: This study aimed to validate the predictive performance of the GERAADA (German Registry for Acute Type A Aortic Dissection) score in predicting 30-day mortality rate in patients with acute type A aortic dissection in China.
METHODS: We retrospectively analyzed 526 patients who underwent surgical treatment for acute type A aortic dissection at our institution between 2018 and 2021. The predictive performance of the GERAADA score was evaluated using calibration (observed-to-expected ratio and Hosmer-Lemeshow test) and discrimination (area under the receiver operating characteristic curve). Logistic regression analysis was performed to identify risk factors of 30-day mortality rate. Stratified analyses were conducted to assess performance across different risk categories.
RESULTS: The cohort exhibited distinct characteristics, including younger age, longer intervals from onset to admission, and more extensive aortic arch procedures. The GERAADA score demonstrated good calibration (Hosmer-Lemeshow test, P=0.461) and discriminative power (area under the receiver operating characteristic curve=0.863). Low-risk patients (score <20; 78.7% of cohort) had a mortality rate of 2.4%, while high-risk patients (score ≥20) showed mortality rates aligning with predicted values (observed-to-expected ratio=1.2). Patients with preoperative critical conditions or end-organ malperfusion exhibited a significantly higher mortality rate. Furthermore, we identified independent risk factors beyond the GERAADA scoring system, and these factors exhibited significant differences between high- and low-risk patients. To address these findings, we developed a mortality risk assessment strategy based on GERAADA score, which further stratifies patients according to their specific clinical characteristics, serving as an optimization and expansion of the GERAADA score.
CONCLUSIONS: This study validated the GERAADA score in China for predicting mortality risk in patients with acute type A aortic dissection, showing strong performance in discrimination and calibration. We also developed a mortality risk assessment strategy based on the GERAADA score, offering a practical framework for clinical use. The modular design allows for easy adaptation across centers, although further multicenter studies are needed to confirm its generalizability.
METHODS: We retrospectively analyzed 526 patients who underwent surgical treatment for acute type A aortic dissection at our institution between 2018 and 2021. The predictive performance of the GERAADA score was evaluated using calibration (observed-to-expected ratio and Hosmer-Lemeshow test) and discrimination (area under the receiver operating characteristic curve). Logistic regression analysis was performed to identify risk factors of 30-day mortality rate. Stratified analyses were conducted to assess performance across different risk categories.
RESULTS: The cohort exhibited distinct characteristics, including younger age, longer intervals from onset to admission, and more extensive aortic arch procedures. The GERAADA score demonstrated good calibration (Hosmer-Lemeshow test, P=0.461) and discriminative power (area under the receiver operating characteristic curve=0.863). Low-risk patients (score <20; 78.7% of cohort) had a mortality rate of 2.4%, while high-risk patients (score ≥20) showed mortality rates aligning with predicted values (observed-to-expected ratio=1.2). Patients with preoperative critical conditions or end-organ malperfusion exhibited a significantly higher mortality rate. Furthermore, we identified independent risk factors beyond the GERAADA scoring system, and these factors exhibited significant differences between high- and low-risk patients. To address these findings, we developed a mortality risk assessment strategy based on GERAADA score, which further stratifies patients according to their specific clinical characteristics, serving as an optimization and expansion of the GERAADA score.
CONCLUSIONS: This study validated the GERAADA score in China for predicting mortality risk in patients with acute type A aortic dissection, showing strong performance in discrimination and calibration. We also developed a mortality risk assessment strategy based on the GERAADA score, offering a practical framework for clinical use. The modular design allows for easy adaptation across centers, although further multicenter studies are needed to confirm its generalizability.