Extension Of Ruptured Abdominal Aortic Aneurysm Mortality Risk Scores To Other Acute Aortic Pathology
Michael A. Ciaramella, B.A., Daniel Ventarola, M.D., Justin Ady, M.D., Saum Rahimi, M.D., William Beckerman, M.D..
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
OBJECTIVES: While there has been considerable interest in developing prognostic tools for predicting mortality after ruptured abdominal aortic aneurysm (rAAA), there have been few attempts at developing similar methodologies for other acute aortic pathology. Three recent methods that have shown promise in predicting mortality after rAAA are the Harborview Medical Center (HMC), Dutch Aneurysm Score (DAS), and Vascular Study Group of New England (VSGNE) risk scores. We attempted to extend use of these scoring systems to life-threatening non-rAAA acute aortic pathology and assess their predictive value in this setting.
METHODS: A retrospective chart review was performed for all patients receiving surgery at our institution for acute aortic pathology between January 1, 2011 and September 15, 2019. This included rupture of descending thoracic aortic aneurysm (rTAA), abdominal aortic aneurysm (rAAA), penetrating aortic ulcer (rPAU), type B aortic dissection (rTBAD), mycotic aortic aneurysm, and aortic trauma with transection or rupture. Pathology involving the ascending aorta or aortic arch were excluded. The database was divided into separate cohorts of patients with rAAA versus non-rAAA acute aortic pathology. HMC, DAS, and VSGNE scores were calculated and tested against 30-day mortality in each cohort. Regression analysis and receiver operating characteristic (ROC) curves were used to compare performance of the scoring systems.
RESULTS: Seventy-nine patients were identified during the study period. Fifteen patients missing key variables were excluded. The first cohort contained 47 patients with rAAA with a mortality rate of 38.3%. The second cohort comprised 17 patients including 6 rTAA, 1 rPAU, 2 rTBAD, 4 mycotic aneurysms, and 4 patients with aortic trauma, with a mortality rate of 29.4%. In cohort one, ROC analysis for the HMC, VSGNE, and DAS scores produced an area under the curve (AUC) of 0.729 (0.584-0.874), 0.693 (0.540-0.845), and 0.646 (0.478-0.813), respectively. In cohort two, ROC analysis produced an AUC of 0.767 (0.505-1.000), 0.800 (0.580-1.000), and 0.683 (0.385-0.982), respectively.
CONCLUSIONS: This study demonstrates preliminary evidence for extension of rAAA mortality risk scores to non-rAAA acute aortic pathology. The HMC and VSGNE scores appear to adequately predict 30-day mortality for rAAA and non-rAAA acute aortic pathology, where the DAS fails to reach significance in either. Further work is needed to explore the full extent of mortality scoring system predictive value in this setting.
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