The German Registry of Acute Aortic Dissection Type A score for 30-day mortality prediction in Type A Acute Aortic Dissection surgery: a systematic review and meta-analysis.

IF 3 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

European Journal of Cardio-Thoracic Surgery Pub Date : 2025-05-06 DOI:10.1093/ejcts/ezaf138

Marco Gemelli, Thanakorn Rojanathagoon, Jef van den Eynde, Enrico G Italiano, Tea Lena, Michel Pompeu Sá, Vito D Bruno, Manraj Sandhu, Robert Pruna-Guillen, Aung Y Oo, Martin Czerny, Michele Gallo, Mark S Slaughter, Vincenzo Tarzia, Eltayeb Mohamed Ahmed, Cha Rajakaruna, Gino Gerosa

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引用次数: 0

Abstract

Objectives: The German Registry of Acute Aortic Dissection Type A (GERAADA) score is a risk score for predicting 30-day mortality after an operation for type A acute aortic dissection (TAAAD). This meta-analysis sought to assess the performance of the GERAADA model and compare it to the performance of the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II).

Methods: A systematic search of 3 online databases was conducted to identify studies that externally validated the GERAADA score. A random-effect meta-analysis was conducted, pooling area under the curve (AUC) data, operative mortality observed/expected (O/E) ratios and observed-expected (O-E) differences-of the GERAADA model in all studies and of the EuroSCORE II when available.

Results: Eleven studies were selected, including a total of 10 360 patients. The observed in-hospital mortality rate was 12.2%. Pooled expected mortality rates estimated by the GERAADA score and the EuroSCORE II were 18.4% and 5.8%, respectively. The pooled analyses for the GERAADA scores showed moderate discrimination [AUC 0.70, 95% confidence interval (CI) 0.66-0.73] and good calibration [observed-expected (O-E) differences -12.3, 95% CI -27.1 to 2.58; O/E ratio 0.81, 95% CI 0.57-1.05]. Results from 5 studies (2133 patients) investigating both scores simultaneously revealed similar AUC results (P = 0.50), significantly lower O-E differences (P = 0.03) and a trend towards O/E ratios closer to 1 (P = 0.08) with the GERAADA score compared to the EuroSCORE II.

Conclusions: The GERAADA score seemed to offer a better calibration for predicting 30-day postoperative death following TAAAD operations, even though further studies are needed to confirm these findings. The moderate discriminatory capacity of both scores highlights the challenges of predicting outcomes in complex cardiovascular conditions like TAAAD.

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德国急性主动脉夹层A型评分对A型急性主动脉夹层手术30天死亡率的预测：一项系统回顾和荟萃分析。

目的：德国急性主动脉夹层A型登记（GERAADA）评分是预测A型急性主动脉夹层（TAAAD）手术后30天死亡率的风险评分。本荟萃分析旨在评估GERAADA模型的性能，并将其与欧洲心脏手术风险评估系统II （EuroSCORE II）的性能进行比较。方法：系统检索3个在线数据库，找出外部验证GERAADA评分的研究。进行随机效应荟萃分析，汇集所有研究中GERAADA模型和EuroSCORE II（可用时）的曲线下面积（AUC）数据、手术死亡率观察/预期（O/E）比率和观察-预期（O-E）差异。结果：入选11项研究，共纳入10360例患者。住院死亡率为12.2%。GERAADA评分和EuroSCORE II估计的合并预期死亡率分别为18.4%和5.8%。对GERAADA评分的合并分析显示，中度差异[AUC 0.70, 95%可信区间（CI） 0.66-0.73]和良好的校准[观察-预期（O-E）差异-12.3,95% CI -27.1至2.58；O/E比值0.81,95% CI 0.57-1.05]。同时调查两种评分的5项研究（2133例患者）的结果显示，与EuroSCORE II相比，GERAADA评分的AUC结果相似（P = 0.50）， O-E差异显著降低（P = 0.03）， O/E比值接近1 （P = 0.08）。结论：GERAADA评分似乎为预测TAAAD手术后30天的术后死亡提供了更好的校准，尽管需要进一步的研究来证实这些发现。两种评分的适度区分能力突出了预测复杂心血管疾病（如TAAAD）预后的挑战。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Cardio-Thoracic Surgery 医学-呼吸系统

CiteScore

5.60

自引率

11.80%

发文量

564

审稿时长

2 months

期刊介绍： The primary aim of the European Journal of Cardio-Thoracic Surgery is to provide a medium for the publication of high-quality original scientific reports documenting progress in cardiac and thoracic surgery. The journal publishes reports of significant clinical and experimental advances related to surgery of the heart, the great vessels and the chest. The European Journal of Cardio-Thoracic Surgery is an international journal and accepts submissions from all regions. The journal is supported by a number of leading European societies.