Development of a scoring system for the involvement of supra-aortic vessel in patients with type A aortic dissection

Background: Stroke is one of the most severe postoperative complications in patients with acute type A aortic dissection (ATAAD). This study aimed to develop a novel scoring system to supplement existing classification systems and evaluate its association with postoperative stroke and other complications. Methods: A total of 257 patients were included in the study. The degree of involvement of the innominate artery (IA), left common carotid artery (LCCA), left subclavian artery (LSA), and right common carotid artery (RCCA) was assigned a score. These scores were then combined, and a grid search was used to determine the coefficient for each variable. The bootstrap method was applied to assess the performance of the scoring formula. The area under the curve (AUC) and odds ratio (OR) were used to evaluate the associations between the score and outcomes, such as stroke. Results: The AUC of the scoring system was 0.811 [95% confidence interval (CI): 0.713-0.909], and the mean AUC from the bootstrap evaluation was 0.813 (95% CI: 0.721-0.903). The optimal cutoff score was found to be 15. The ORs for stroke associated with the score and cutoff score were 1.21 (95% CI: 1.14-1.29) and 10.13 (95% CI: 4.36-23.58), respectively. After adjusting for non-anatomical risk factors, the adjusted ORs were 1.22 (95% CI: 1.14-1.31) and 13.30 (95% CI: 5.21-33.93). The scoring system and its cutoff value were also identified as significant risk factors for postoperative death and delayed awakening. Conclusions: The newly developed scoring system effectively evaluates the risk of postoperative stroke in patients with ATAAD and provides additional predictive value for postoperative death and delayed awakening.