Simple risk models to predict surgical mortality in acute type A aortic dissection: The International Registry of Acute Aortic Dissection score
Simple risk models to predict surgical mortality in acute type A aortic dissection: The International Registry of Acute Aortic Dissection score
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DOI：
10.1016/j.athoracsur.2006.08.007
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发表时间：
2007-01-01
影响因子：
4.6
通讯作者：
Isselbacher, Eric M.
中科院分区：
文献类型：
--
作者：
Rampoldi, Vincenzo;Trimarchi, Santi;Isselbacher, Eric M.
背景。急性A型主动脉夹层的手术死亡率通常与术前临床状况有关。我们报告了一个预测评分来识别死亡风险，这可能有助于外科医生考虑是否在极端临床风险患者的情况下进行手术矫正。分析了1996年至2003年国际急性主动脉夹层登记处登记的682例患者的手术结果。使用了两种不同的模型。初始模型仅包括术前变量，如人口统计学、病史、症状、体征和诊断方法（模型1）。第二个模型还测试了术中血流动力学和手术变量（模型2）。开发了一种床边风险预测工具，用于预测个体患者的手术死亡率。住院手术总死亡率为23.9%。模型1中死亡率的独立术前预测因素为：年龄大于70岁、既往心脏手术、低血压（收缩压小于100 mm Hg）或出现时休克、迁移性疼痛、心脏填塞、任何脉搏缺陷以及心电图显示心肌缺血或梗死。在模型2中，手术死亡的其他预测因素是术中低血压、术中右心室功能障碍和需要进行冠状动脉血运重建术。右腹置换术是手术预后良好的独立预测因素。手术治疗不稳定的急性A型主动脉夹层患者可能非常不成功。国际注册急性主动脉夹层风险模型使用多变量风险预测工具预测住院死亡率，这对外科医生和患者在考虑手术风险和进行高风险手术的利弊时很有用。
Background. Surgical mortality for acute type A aortic dissection is frequently related to preoperative clinical conditions. We report a predictive score to identify risk of death that may be helpful to assist surgeons who are considering whether to proceed with surgical correction in the case of patients in extreme clinical risk.Methods. Surgical outcome of 682 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2003 was analyzed. Two different models were used. The initial model included only preoperative variables such as demographics, history, symptoms, signs, and diagnostic methods (model 1). The second model also tested intraoperative hemodynamic and surgical variables (model 2). A bedside risk prediction tool to predict operative mortality in individual patients was developed.Results. The overall in-hospital surgical mortality was 23.9%. Independent preoperative predictors of mortality in model 1 were age greater than 70 years, prior cardiac surgery, hypotension (systolic blood pressure less than 100 mm Hg) or shock at presentation, migrating pain, cardiac tamponade, any pulse deficit, and electrocardiogram with findings of myocardial ischemia or infarction. In model 2, other predictors of surgical death were intraoperative hypotension, a right ventricle dysfunction at surgery, and a necessity to perform coronary revascularization. An independent predictor for favorable surgical outcome was right hemiarch replacement.Conclusions. Surgery in unstable patients with acute type A aortic dissection can be highly unsuccessful. The International Registry of Acute Aortic Dissection risk models predict in-hospital mortality using a multivariable risk prediction tool, useful for surgeons and patients as they consider their surgical risk and the pros and cons of embarking on high-risk surgery.