Adaption of EuroSCORE II to predict mortality in acute type A aortic dissection: an effort to make fit what does not
Martin Czerny
Abstract
NežIć et al. present a manuscript in which they apply 2 risk stratification systems to the prediction of outcomes of a single disease. Only one of these risk stratification systems is specifically designed for this disease. This system was generated from data of patients who had the disease, namely from the German Registry of Acute Aortic Dissection Type A (GERAADA) score, a unique tool for predicting 30-day mortality in patients undergoing surgery for acute type A aortic dissection [1, 2]. The score has already been externally validated and works exceedingly well [3]. The other tool, the EuroSCORE II, was designed for patients undergoing adult cardiac surgery, mainly for structural heart valve disease and/or coronary artery disease [4]. The authors adapt a different score to make it fit, scotomizing the background being generation out of data from patients who did not have the disease they want to address. The relationships presented are questionable and might even be dangerous: 1 example is the equation for extracardiac arteriopathy and cerebral malperfusion, which goes against the fundamental nature of the disease. Acute aortic dissection that causes cerebral malperfusion (usually highly symptomatic) and chronic obliterative arteriopathy (usually completely asymptomatic) are almost always mutually exclusive. Fabricating such a connection indicates a fundamental ignorance of the pathophysiology of the underlying disease processes.