Risk score system for late aortic events in patients with uncomplicated type B aortic dissection

Akihito Matsushita, Minoru Tabata, Wahei Mihara, Takeshi Shimamoto, Tatsuhiko Komiya, Shuichiro Takanashi, Tetsuya Tobaru, Tatsuya Nakao, Sunao Nakamura, Yasunori Sato

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Several risk factors for late aortic events in patients with uncomplicated type B aortic dissection (UTBAD) have been reported; however, they remain controversial. We developed and validated a new risk prediction score system for late aortic events in patients with UTBAD. Methods: We reviewed 187 consecutive patients diagnosed with UTBAD from 2004 to 2017 at 2 centers (derivation cohort) and 219 consecutive patients diagnosed with UTBAD from 2012 to 2016 in 4 other centers (validation cohort). We explored predictors of late aortic events using Fine-Gray generalization of the proportional hazards model, then developed a risk prediction score model and determined the test reliability using time-dependent receiver operating characteristic analyses. Finally, we validated the model using external multicenter data. Results: The risk prediction score system was developed using the following independent predictors: initial aortic diameter of ≥40 mm (2 points), false lumen diameter larger than true lumen diameter (2 points), ulcer-like projection (1 point), and age ≥70 years (1 point). Receiver operating characteristic analysis showed that a cut-off total additive score of 2 points. In the validation cohort, the low-risk group (score, 0-1 point) demonstrated lower 1- and 3-year incidence rates of late aortic events than the high-risk group (score, 2-6 points) (0.9% vs 32.5% and 0.9% vs 47.1%, respectively; P < .0001). Conclusions: We developed a simple risk prediction score system for late aortic events in patients with UTBAD. High-risk patients can be identified using our model, and they should be closely monitored and considered for interventions at the appropriate timing.

Original languageEnglish
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
Publication statusPublished - 2019 Jan 1

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Dissection
ROC Curve
Proportional Hazards Models
Ulcer
Incidence

Keywords

  • acute type B aortic dissection
  • aortic events
  • predictors
  • uncomplicated

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Risk score system for late aortic events in patients with uncomplicated type B aortic dissection. / Matsushita, Akihito; Tabata, Minoru; Mihara, Wahei; Shimamoto, Takeshi; Komiya, Tatsuhiko; Takanashi, Shuichiro; Tobaru, Tetsuya; Nakao, Tatsuya; Nakamura, Sunao; Sato, Yasunori.

In: Journal of Thoracic and Cardiovascular Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Matsushita, A, Tabata, M, Mihara, W, Shimamoto, T, Komiya, T, Takanashi, S, Tobaru, T, Nakao, T, Nakamura, S & Sato, Y 2019, 'Risk score system for late aortic events in patients with uncomplicated type B aortic dissection', Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2019.06.019
Matsushita, Akihito ; Tabata, Minoru ; Mihara, Wahei ; Shimamoto, Takeshi ; Komiya, Tatsuhiko ; Takanashi, Shuichiro ; Tobaru, Tetsuya ; Nakao, Tatsuya ; Nakamura, Sunao ; Sato, Yasunori. / Risk score system for late aortic events in patients with uncomplicated type B aortic dissection. In: Journal of Thoracic and Cardiovascular Surgery. 2019.
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abstract = "Objective: Several risk factors for late aortic events in patients with uncomplicated type B aortic dissection (UTBAD) have been reported; however, they remain controversial. We developed and validated a new risk prediction score system for late aortic events in patients with UTBAD. Methods: We reviewed 187 consecutive patients diagnosed with UTBAD from 2004 to 2017 at 2 centers (derivation cohort) and 219 consecutive patients diagnosed with UTBAD from 2012 to 2016 in 4 other centers (validation cohort). We explored predictors of late aortic events using Fine-Gray generalization of the proportional hazards model, then developed a risk prediction score model and determined the test reliability using time-dependent receiver operating characteristic analyses. Finally, we validated the model using external multicenter data. Results: The risk prediction score system was developed using the following independent predictors: initial aortic diameter of ≥40 mm (2 points), false lumen diameter larger than true lumen diameter (2 points), ulcer-like projection (1 point), and age ≥70 years (1 point). Receiver operating characteristic analysis showed that a cut-off total additive score of 2 points. In the validation cohort, the low-risk group (score, 0-1 point) demonstrated lower 1- and 3-year incidence rates of late aortic events than the high-risk group (score, 2-6 points) (0.9{\%} vs 32.5{\%} and 0.9{\%} vs 47.1{\%}, respectively; P < .0001). Conclusions: We developed a simple risk prediction score system for late aortic events in patients with UTBAD. High-risk patients can be identified using our model, and they should be closely monitored and considered for interventions at the appropriate timing.",
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AU - Tabata, Minoru

AU - Mihara, Wahei

AU - Shimamoto, Takeshi

AU - Komiya, Tatsuhiko

AU - Takanashi, Shuichiro

AU - Tobaru, Tetsuya

AU - Nakao, Tatsuya

AU - Nakamura, Sunao

AU - Sato, Yasunori

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N2 - Objective: Several risk factors for late aortic events in patients with uncomplicated type B aortic dissection (UTBAD) have been reported; however, they remain controversial. We developed and validated a new risk prediction score system for late aortic events in patients with UTBAD. Methods: We reviewed 187 consecutive patients diagnosed with UTBAD from 2004 to 2017 at 2 centers (derivation cohort) and 219 consecutive patients diagnosed with UTBAD from 2012 to 2016 in 4 other centers (validation cohort). We explored predictors of late aortic events using Fine-Gray generalization of the proportional hazards model, then developed a risk prediction score model and determined the test reliability using time-dependent receiver operating characteristic analyses. Finally, we validated the model using external multicenter data. Results: The risk prediction score system was developed using the following independent predictors: initial aortic diameter of ≥40 mm (2 points), false lumen diameter larger than true lumen diameter (2 points), ulcer-like projection (1 point), and age ≥70 years (1 point). Receiver operating characteristic analysis showed that a cut-off total additive score of 2 points. In the validation cohort, the low-risk group (score, 0-1 point) demonstrated lower 1- and 3-year incidence rates of late aortic events than the high-risk group (score, 2-6 points) (0.9% vs 32.5% and 0.9% vs 47.1%, respectively; P < .0001). Conclusions: We developed a simple risk prediction score system for late aortic events in patients with UTBAD. High-risk patients can be identified using our model, and they should be closely monitored and considered for interventions at the appropriate timing.

AB - Objective: Several risk factors for late aortic events in patients with uncomplicated type B aortic dissection (UTBAD) have been reported; however, they remain controversial. We developed and validated a new risk prediction score system for late aortic events in patients with UTBAD. Methods: We reviewed 187 consecutive patients diagnosed with UTBAD from 2004 to 2017 at 2 centers (derivation cohort) and 219 consecutive patients diagnosed with UTBAD from 2012 to 2016 in 4 other centers (validation cohort). We explored predictors of late aortic events using Fine-Gray generalization of the proportional hazards model, then developed a risk prediction score model and determined the test reliability using time-dependent receiver operating characteristic analyses. Finally, we validated the model using external multicenter data. Results: The risk prediction score system was developed using the following independent predictors: initial aortic diameter of ≥40 mm (2 points), false lumen diameter larger than true lumen diameter (2 points), ulcer-like projection (1 point), and age ≥70 years (1 point). Receiver operating characteristic analysis showed that a cut-off total additive score of 2 points. In the validation cohort, the low-risk group (score, 0-1 point) demonstrated lower 1- and 3-year incidence rates of late aortic events than the high-risk group (score, 2-6 points) (0.9% vs 32.5% and 0.9% vs 47.1%, respectively; P < .0001). Conclusions: We developed a simple risk prediction score system for late aortic events in patients with UTBAD. High-risk patients can be identified using our model, and they should be closely monitored and considered for interventions at the appropriate timing.

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