Predictive Value of Risk Scores and Classifications in Acute Type-A Aortic Dissections

Background: Prognostic risk models are an important but also determining tool estimating operative morbidity and mortality, particularly in type-A aortic dissection. This retrospective study aimed to evaluate the comparative accuracy of common risk scores and classification in a high-volume aortic center.

Methods: Between January 2020 and December 2022, 167 consecutive patients (mean age 68 ± 14, 64% male) presenting with acute type-A aortic dissection were included. Risk scores (STS, EUROScore II, GEERADA, and Adjusted Leipzig Halifax [LHA]) were calculated assessing their performance using correlation analysis, mortality rates, and ANOVA. With focus on malperfusion, the cohort was classified according to the PENN and TEM classifications and effectiveness was evaluated.

Results: Overall 30-day mortality was 20.96%. All scores showed significant correlation with observed mortality (p < 0.001), with GERAADA demonstrating the strongest correlation (r = 0.554). However, all scores revealed similar discriminative power (AUC: EUROscore II 0.847, STS 0.847, GERAADA 0.818, LHA 0.806). A subgroup of 113 patients suffered from malperfusion and experienced a significantly increased mortality (26.6% versus 9.3%, p = 0.008). Using PENN Classification, all scores except LHA (r = 0.3) showed good positive correlation for high-risk patients (PENN B-C and C, r = 0.51–0.58) with the GERAADA score performing best. According to TEM classification, strong correlations were observed for visceral or cerebral malperfusion across all scores (r = 0.65–0.76) as well as multiple malperfusion areas (0.61–0.83). In general, GERAADA demonstrated the most consistent performance across PENN and TEM classification. The LHA and STS scores show strong performance in higher risk categories (PENN C, and multiple malperfusion), while the performance of EuroSCORE II was variable.

Conclusion: All investigated risk scores predict our institutional mortality in acute type-A aortic dissection surgery sufficiently with the best correlation for the GERAADA score. However, in the presence of malperfusion, the performance varies significantly. The scores excel in identifying high-risk patients with severe malperfusion but show limitations in differentiating among less severe presentations. However, the GERAADA score demonstrates particular strength in assessing malperfusion-related risks.

Publication History

Article published online:
11 February 2025