Long-term prognostic value of the combined assessment of clinical and computed tomography findings in type: An acute aortic dissection

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.

Figure 1

Flowchart of the study population enrollment process.

Figure 2

CT images show severe kidney malperfusion (A) and the descending aorta size (B) of an 88-yr-old male with TAAAD. (A) Left kidney artery occlusion (arrow) and decreased contrast-enhancement of the left kidney (arrowhead) can be seen. (B) The largest short-axial diameter (double arrow) of the descending aorta was dilated to 41.5 mm at the time of measurement. The patient received dialysis after hemiarch replacement and died 13 mo later. CT = confidence interval.

Figure 3

Kaplan–Meier survival curves for sex, kidney malperfusion, and descending aorta size. Patients categorized by sex (A), kidney malperfusion (B), descending aorta size (37.7 mm) (C) differed significantly in survival probability (log rank P = <.01).

Figure 4

Receiver operating characteristic curve for the prediction of long-term death in patients with TAAAD. The combined model yielded an AUC of 0.82 (P ≤ .01). AUC = area under the receiver operating characteristic curve, TAAAD = type A acute aortic dissection.