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

4 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
Pages (from-to)2173-2183.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume159
Issue number6
DOIs
Publication statusPublished - 2020 Jun

Keywords

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

ASJC Scopus subject areas

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

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    Matsushita, A., Tabata, M., Mihara, W., Shimamoto, T., Komiya, T., Takanashi, S., Tobaru, T., Nakao, T., Nakamura, S., & Sato, Y. (2020). Risk score system for late aortic events in patients with uncomplicated type B aortic dissection. Journal of Thoracic and Cardiovascular Surgery, 159(6), 2173-2183.e1. https://doi.org/10.1016/j.jtcvs.2019.06.019