Validation of the GERAADA Score for Predicting 30-Day Mortality Rate in Acute Type A Aortic Dissection: A...

This study aimed to validate the predictive performance of the GERAADA (German Registry for Acute Type A Aortic Dissection) score in predicting 30-day mortality rate in patients with acute type A aortic dissection in China.

We retrospectively analyzed 526 patients who underwent surgical treatment for acute type A aortic dissection at our institution between 2018 and 2021. The predictive performance of the GERAADA score was evaluated using calibration (observed-to-expected ratio and Hosmer-Lemeshow test) and discrimination (area under the receiver operating characteristic curve). Logistic regression analysis was performed to identify risk factors of 30-day mortality rate. Stratified analyses were conducted to assess performance across different risk categories.

The cohort exhibited distinct characteristics, including younger age, longer intervals from onset to admission, and more extensive aortic arch procedures. The GERAADA score demonstrated good calibration (Hosmer-Lemeshow test, P=0.461) and discriminative power (area under the receiver operating characteristic curve=0.863). Low-risk patients (score <20; 78.7% of cohort) had a mortality rate of 2.4%, while high-risk patients (score ≥20) showed mortality rates aligning with predicted values (observed-to-expected ratio=1.2). Patients with preoperative critical conditions or end-organ malperfusion exhibited a significantly higher mortality rate. Furthermore, we identified independent risk factors beyond the GERAADA scoring system, and these factors exhibited significant differences between high- and low-risk patients. To address these findings, we developed a mortality risk assessment strategy based on GERAADA score, which further stratifies patients according to their specific clinical characteristics, serving as an optimization and expansion of the GERAADA score.

This study validated the GERAADA score in China for predicting mortality risk in patients with acute type A aortic dissection, showing strong performance in discrimination and calibration. We also developed a mortality risk assessment strategy based on the GERAADA score, offering a practical framework for clinical use. The modular design allows for easy adaptation across centers, although further multicenter studies are needed to confirm its generalizability.