On-line risk prediction models for acute type A aortic dissection surgery: validation of the German Registry of Acute Aortic Dissection Type A score and the European System for Cardiac Operative Risk Evaluation II

Abstract

OBJECTIVES The German Registry of Acute Aortic Dissection Type A (GERAADA) on-line score calculator to predict 30-day mortality in patients undergoing surgery for acute type A aortic dissection (ATAAD) was recently launched. Using the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), it is also possible to predict operative mortality for the same type of surgery. The goal of our study was to validate the prediction accuracy of these 2 on-line risk prediction models. METHODS Prospectively collected data for EuroSCORE II risk factors as well as all data for GERAADA scoring were extracted from an institutional database for 147 patients who underwent surgery for ATAAD between April 2018 and April 2021. The discriminative power was assessed using area under the receiver operating characteristic curve. The calibration of the models was tested by the Hosmer–Lemeshow statistics and by using the observed-to-expected (O/E) mortality ratio with the 95% confidence interval. RESULTS The observed operative mortality was 14.3%. The mean predicted mortality rates for the GERAADA score and the EuroSCORE II were 15.6% and 10.6%, respectively. The EuroSCORE II discriminative power (area under the curve = 0.799) significantly outperformed the discriminatory power of the GERAADA score (area under the curve = 0.550). The Hosmer–Lemeshow statistics confirmed good calibration for both models (P-values of 0.49 and 0.29 for the GERAADA score and the EuroSCORE II, respectively). The O/E mortality ratio certified good calibration for both scores [GERAADA score (O/E ratio of 0.93, 95% confidence interval: 0.53–1.33); EuroSCORE II (O/E ratio of 1.35, 95% confidence interval: 0.77–1.93)]. CONCLUSIONS The EuroSCORE II has better discriminative power for predicting operative mortality in ATAAD surgery than the GERAADA score. Both scores confirmed good calibration ability.

Validation of the German Registry for Acute Aortic Dissection Type A Score in predicting 30-day mortality after type A aortic dissection surgery

“…A precise definition and inclusion/exclusion criteria for the GERAADA score are not present on the website and in the original paper ( https://www.dgthg.de/de/GERAADA_Score ). One of the criticisms of the GERAADA score is related to the unclear definition of the different types of malperfusion as precise definitions of coronary, visceral and peripheral malperfusion are not available [ 13 ]. For these reasons, we have introduced the concepts of clinical and radiological GERAADA score and the second aim of our study is to compare these 2 different ways of calculating it.…”

Serum NPTX2 as a Potential Predictive Biomarker for Postoperative Delirium in Patients with Acute Type A Aortic Dissection

“… 24 However, our study did not observe significant differences in EuroSCORE II scores between the non-POD and POD groups in ATAAD surgeries, despite its reputed efficacy in predicting operative mortality in these cases. 25 On the other hand, the GERAADA score, a straightforward and effective metric for predicting 30-day mortality in patients undergoing ATAAD surgery, 26 displayed notable differences. This finding suggests that the GERAADA score may be more indicative of delirium risk than the EuroSCORE II in these patients.…”

Prediction Nomogram for Postoperative 30-Day Mortality in Acute Type A Aortic Dissection Patients Receiving Total Aortic Arch Replacement With Frozen Elephant Trunk Technique

“…This is especially important considering the many regional differences in etiology, access to technologies, care systems, and guidelines. Nežić et al (20) reported their validation study (n = 137) on GERAADA score revealing that the discrimination of GERAADA score was poor, with an AUC of 0.55, much lower than the EuroSCORE II score (AUC = 0.799). Therefore, developing a prediction model for TAR+FET in the Chinese population is of major clinical importance.…”