Risk score system for late aortic events in patients with uncomplicated type B aortic dissection.
OBJECTIVE
Several risk factors for late aortic events in patients with uncomplicated type B aortic dissection (UTBAD) have been reported; however, they remain controversial. We developed and validated a new risk prediction score system for late aortic events in patients with UTBAD.


METHODS
We reviewed 187 consecutive patients diagnosed with UTBAD from 2004 to 2017 at 2 centers (derivation cohort) and 219 consecutive patients diagnosed with UTBAD from 2012 to 2016 in 4 other centers (validation cohort). We explored predictors of late aortic events using Fine-Gray generalization of the proportional hazards model, then developed a risk prediction score model and determined the test reliability using time-dependent receiver operating characteristic analyses. Finally, we validated the model using external multicenter data.


RESULTS
The risk prediction score system was developed using the following independent predictors: initial aortic diameter of ≥40 mm (2 points), false lumen diameter larger than true lumen diameter (2 points), ulcer-like projection (1 point), and age ≥70 years (1 point). Receiver operating characteristic analysis showed that a cut-off total additive score of 2 points. In the validation cohort, the low-risk group (score, 0-1 point) demonstrated lower 1- and 3-year incidence rates of late aortic events than the high-risk group (score, 2-6 points) (0.9% vs 32.5% and 0.9% vs 47.1%, respectively; P < .0001).


CONCLUSIONS
We developed a simple risk prediction score system for late aortic events in patients with UTBAD. High-risk patients can be identified using our model, and they should be closely monitored and considered for interventions at the appropriate timing.
['Matsushita|Akihito|A|', 'Tabata|Minoru|M|', 'Mihara|Wahei|W|', 'Shimamoto|Takeshi|T|', 'Komiya|Tatsuhiko|T|', 'Takanashi|Shuichiro|S|', 'Tobaru|Tetsuya|T|', 'Nakao|Tatsuya|T|', 'Nakamura|Sunao|S|', 'Sato|Yasunori|Y|']
D000367:Age Factors D000368:Aged D000784:Aneurysm, Dissecting D001014:Aortic Aneurysm D001027:Aortography D000066491:Clinical Decision-Making D000072226:Computed Tomography Angiography D003661:Decision Support Techniques D005260:Female D006801:Humans D015994:Incidence D007564:Japan D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D011379:Prognosis D015203:Reproducibility of Results D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors
aortic events uncomplicated predictors acute type B aortic dissection