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Predicting Late Adverse Events in Uncomplicated Stanford Type B Aortic Dissection: Results From the ROADMAP
Dominik Fleischmann1, Domenico Mastrodicasa1, Martin J Willemink1
1Department of Radiology (D.F., D.M., M.J.W., V.L.T., V.H., M.C., A.M.S., G.M., M.H.M., K.B., J.S., K.M.L.), Stanford University School of Medicine, CA.
Circulation. Cardiovascular Imaging
|February 18, 2025
Summary
A prediction model for late adverse events in Stanford type B aortic dissection showed poor performance. Maximum aortic diameter is the most significant predictor for these events.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Epidemiology
Background:
- Risk stratification is crucial for uncomplicated Stanford type B aortic dissection but lacks robust evidence.
- A previously published prediction model utilized clinical and imaging variables for late adverse events (LAEs).
Purpose of the Study:
- To externally validate a published prediction model for LAEs in patients with uncomplicated Stanford type B aortic dissection.
- To assess the model's performance in a new cohort and identify key predictors of LAEs.
Main Methods:
- A retrospective multicenter cohort (ROADMAP) of 401 patients with uncomplicated Stanford type B aortic dissection was assembled.
- The original prediction model's parameters were applied to the validation cohort, with LAEs defined as rupture, refractory hypertension, ischemia, or aneurysm formation/growth.
- Statistical analysis included multivariable Cox regression to identify predictors of LAEs.
Main Results:
- Of 225 patients in the final cohort, 40% experienced LAEs, primarily aneurysm formation.
- Maximum aortic diameter was significantly larger in patients with LAEs (42.6 mm vs. 39.9 mm, P=0.001).
- Only maximum aortic diameter independently predicted LAEs (HR, 1.07 per mm; P<0.001), while other model parameters did not.
- The original prediction model demonstrated poor 5-year sensitivity (38%) and specificity (69%) in the validation cohort.
Conclusions:
- The clinical and imaging-based prediction model performed poorly in the ROADMAP cohort.
- Maximum aortic diameter remains the strongest predictor of late adverse events in uncomplicated Stanford type B aortic dissection.
- Further research is needed to develop more accurate risk stratification tools for this patient population.
