Risk stratification in acute type A dissection: Proposition for a new scoring system

Background. The aim of this study was to develop a scoring system for opera tive mortality of patients with acute type A aortic dissection. Methods. Between 1974 and 1999, a total of 252 patients were operated on fo r an acute type A aortic dissection. We reviewed retrospectively preoperati ve and intraoperative records to conduct an analysis of risk factors associ ated with surgery. Multivariate analysis was used to predict operative mort ality and to provide a preoperative risk profile of each individual patient that could be used for future patients. Results. Operative mortality was 25.0% (n = 63). A logistic regression mode l with three explanatory variables to predict operative death showed a good fit: the risk factors associated with operative mortality were preoperativ e cardiopulmonary resuscitation (p = 0.0013, odds ratio 15.7) and iatrogeni c dissection (p = 0.0014, odds ratio 9.8). Drained pericardial tamponade (p = 0.0386, odds ratio = 0.12) appeared to be a protective factor associated with decreased mortality. Conclusions. Because existing scoring systems do not fit this pathologic co ndition, we propose the use of this Antonius Dissection Scoring System, bas ed on the logistic regression model, to predict the chances of operative mo rtality for each patient before operation. The survival of patients with co ncomittant pericardial tamponade may benefit from pericardial drainage. (C) 2001 by The Society of Thoracic Surgeons.