Long-term prognostic value of the combined assessment of clinical and computed tomography findings in type

Abstract

Type A acute aortic dissection (TAAAD) carries a high mortality rate in the absence of surgical treatment. This study sought to determine whether combining the assessment of clinical and computed tomography (CT) findings can be used to predict the long-term all-cause mortality rate of patients with TAAAD. Eighty-five consecutive patients with TAAAD who had undergone CT imaging and surgery were retrospectively reviewed. For the clinical and CT findings, univariate testing followed by multivariate logistic regression analysis was conducted to identify independent predictors of death. Then, the area under the receiver operating characteristic curve of the combined prediction model was calculated. The long-term mortality rate was 34.1% in our cohort (a median follow-up period of 60 months). Multivariate logistic regression analysis identified the following presenting variables as predictors of death: male sex (odds ratio [OR]: 6.67; 95% confidence interval [CI]: 1.67–25.0; P = .007), kidney malperfusion (OR: 2.18; 95% CI: 1.16–4.1; P = .02), and descending aorta size (OR: 1.12; 95% CI: 1.00–1.25; P = .05). Receiver operating characteristic curve analysis revealed an area under the receiver operating characteristic curve of 0.84 when using the combined model for prediction of long-term all-cause mortality ( P ≤ .01). The combined assessment of clinical and CT findings can reasonably predict the long-term prognosis of TAAAD with surgery.

Sex differences in long-term outcomes following surgery for acute type A aortic dissection: a systematic review and meta-analysis

“…Across the 15 included studies, there were 7,608 male and 3,989 female patients. Of these, 12 reported single-center retrospective data (10,11,19,(26)(27)(28)(29)(30)(31)(32)(33)(34), one reported multi-center data 35, and two reported on large multi-center national or international datasets (9,17). A total of 13 studies published Kaplan-Meier curves for survival (9)(10)(11)19,(26)(27)(28)(30)(31)(32)(33)(34)(35) and four studies published curves for reoperation (9,17,19,28) and were subsequently included in the respective pooled Kaplan-Meier analyses.…”

“…Of these, 12 reported single-center retrospective data (10,11,19,(26)(27)(28)(29)(30)(31)(32)(33)(34), one reported multi-center data 35, and two reported on large multi-center national or international datasets (9,17). A total of 13 studies published Kaplan-Meier curves for survival (9)(10)(11)19,(26)(27)(28)(30)(31)(32)(33)(34)(35) and four studies published curves for reoperation (9,17,19,28) and were subsequently included in the respective pooled Kaplan-Meier analyses. Two studies included cohorts starting from the earliest timepoint and followed patients over the longest time span from 1996-2018 (9,32).…”

“…Nine of 16 studies included were scored eight or nine points suggesting they have good quality (9,11,17,19,(26)(27)(28)(29)32). Three studies scored less than six points which was due to no description of comparability of cohorts, or lack of information about the method for outcomes ascertainment and assessment (10,30,33). The 12 studies scored as having moderate to good quality (NOS scores ≥6) included a total of 6,947 men and 3,707 women.…”