Evaluation of the GERAADA score for prediction of 30-day mortality in patients with acute type A aortic dissection
Evaluation of the GERAADA score for prediction of 30-day mortality in patients with acute type A aortic dissection
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DOI：
10.1093/ejcts/ezaa455
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发表时间：
2021-05-01
影响因子：
3.4
通讯作者：
Wahlers, Thorsten
中科院分区：
文献类型：
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作者：
Luehr, Maximilian;Merkle-Storms, Julia;Wahlers, Thorsten
目的：德国急性A型主动脉夹层登记处（GERAADA）评分预测急性A型主动脉夹层（AADA）患者30天死亡率最近被引入。本研究的目的是评估GERAADA评分的预测值是否与作者的机构结果相一致。方法：纳入2010年至2020年期间所有连续的AADA患者。回顾性数据收集包括11个术前参数：年龄、性别、既往心脏手术、转诊时的正性肌力支持、术前复苏、主动脉瓣返流、术前轻偏瘫、转诊时的插管/通气、术前器官灌注不良、主动脉夹层扩展和主要进入部位的位置。GERAADA评分的计算由对所有患者的研究不知情的心脏外科医生通过基于网络的应用程序（https：//www.dgthg.de/de/GERAADA_Score）单独进行。平均年龄为62.7 ± 13.5岁，233例（63%）为男性。对于整个研究队列（实际与预测的30天死亡率：15.1% vs 15.7%; P = 0.776）以及所有26个亚组，30天死亡率预测均准确。此外，术前复苏（P < 0.001），高龄（P = 0.042）和其他/未知灌注不良（P = 0.032）被确定为独立的危险因素。结论：GERAADA评分预测术后30天死亡率是准确的，易于访问，由于其基于网络的平台，可以计算非常基本的术前临床参数。需要进行一项前瞻性临床试验，以进一步评估新的GERAADA评分作为一种有用的工具，以改善AADA紧急情况下的决策。
OBJECTIVES: The German Registry of Acute Aortic Dissection Type A (GERAADA) score to predict 30-day mortality in patients suffering from acute aortic dissection type A (AADA) was recently introduced. The aim of this study was to evaluate if the GERAADA score's prediction corresponds with the authors' institutional results.METHODS: All consecutive AADA patients between 2010 and 2020 were included. Retrospective data collection comprised 11 preoperative parameters: age, sex, previous cardiac surgery, inotropic support at referral, resuscitation before surgery, aortic regurgitation, preoperative hemiparesis, intubation/ventilation at referral, preoperative organ malperfusion, extension of aortic dissection and location of primary entry site. Calculations of the GERAADA score were individually performed by a cardiac surgeon blinded to the study for all patients via a web-based application (https://www.dgthg.de/de/GERAADA_Score).RESULTS: A total of 371 AADA patients were operated at the authors' institution. The mean age was 62.7 +/- 13.5 years and 233 (63%) were males. Prediction of 30-day mortality was accurate for the entire study cohort (actual vs predicted 30-day mortality: 15.1% vs 15.7%; P = 0.776) as well as for all 26 subgroups. In addition, preoperative resuscitation (P < 0.001), advanced age (P = 0.042) and other/unknown malperfusion (P = 0.032) were identified as independent risk factors.CONCLUSIONS: The GERAADA score prediction of 30-day mortality after surgery is accurate, easily accessible due to its web-based platform and can be calculated with very basic preoperative clinical parameters. A prospective clinical trial is required to further evaluate the new GERAADA score as a useful tool to allow for improved decision-making in the emergency setting of AADA.