title: Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score.
abstract: BACKGROUND
  Surgical mortality for acute type A aortic dissection is frequently related to preoperative clinical conditions. We report a predictive score to identify risk of death that may be helpful to assist surgeons who are considering whether to proceed with surgical correction in the case of patients in extreme clinical risk.
  
  
  METHODS
  Surgical outcome of 682 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2003 was analyzed. Two different models were used. The initial model included only preoperative variables such as demographics, history, symptoms, signs, and diagnostic methods (model 1). The second model also tested intraoperative hemodynamic and surgical variables (model 2). A bedside risk prediction tool to predict operative mortality in individual patients was developed.
  
  
  RESULTS
  The overall in-hospital surgical mortality was 23.9%. Independent preoperative predictors of mortality in model 1 were age greater than 70 years, prior cardiac surgery, hypotension (systolic blood pressure less than 100 mm Hg) or shock at presentation, migrating pain, cardiac tamponade, any pulse deficit, and electrocardiogram with findings of myocardial ischemia or infarction. In model 2, other predictors of surgical death were intraoperative hypotension, a right ventricle dysfunction at surgery, and a necessity to perform coronary revascularization. An independent predictor for favorable surgical outcome was right hemiarch replacement.
  
  
  CONCLUSIONS
  Surgery in unstable patients with acute type A aortic dissection can be highly unsuccessful. The International Registry of Acute Aortic Dissection risk models predict in-hospital mortality using a multivariable risk prediction tool, useful for surgeons and patients as they consider their surgical risk and the pros and cons of embarking on high-risk surgery.
authors.affiliation: Cardiovascular Center E. Malan, Policlinico S. Donato, S. Donato Milanese, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Rampoldi
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.forename: Truls
authors.initials: T
authors.lastname: Myrmel
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Sangiorgi
authors.forename: Carlo
authors.initials: C
authors.lastname: De Vincentiis
authors.forename: Jeanna V
authors.initials: JV
authors.lastname: Cooper
authors.forename: Jianming
authors.initials: J
authors.lastname: Fang
authors.forename: Dean
authors.initials: D
authors.lastname: Smith
authors.forename: Thomas
authors.initials: T
authors.lastname: Tsai
authors.forename: Arun
authors.initials: A
authors.lastname: Raghupathy
authors.forename: Rossella
authors.initials: R
authors.lastname: Fattori
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.forename: Michael G
authors.initials: MG
authors.lastname: Deeb
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012042:Registries; D012306:Risk