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Ann Thorac Surg 2007;84:1070
© 2007 The Society of Thoracic Surgeons

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Correspondence

Can the Risk Associated With Surgery in Type A Aortic Dissection Be Predicted Accurately?

^a Cardiac Surgery Department, Hospital Virgen de la Salud, Avenida de Irlanda 6 3 B, Toledo, 45005 Spain
^b Xcellent Group Researchers

(Email: plima{at}sescam.jccm.es).

To the Editor:

We would like to congratulate Centofanti and colleagues [1] for their impressive work and their excellent results in a complex set of patients and pathology.

We have tried to verify their risk prediction system in a cooperative database recently assembled in Spain, called the XCELLENT dataset. It accounts for the whole caseload of 14 centers across the country that voluntarily summated their activity throughout the year 2004 and underwent a complex peer-review procedure to assess the accuracy of the data. It consists of 6,508 registries with more than 72 variables for each case.

We filtered the acute aortic patients and applied the proposed system to the resulting subset of 110 cases. The model predicted mortality was 23.45% (standard deviation, 10.67%) and the observed mortality was 32.7%.

The Hosmer-Lemeshow goodness-of-fit test was used to assess how the model was calibrated, and the calibration was good (² = 12.65; p = 0.13), without significant differences in several risks groups.

The discriminatory ability of this risk model on the prediction of mortality was measured by reporting the c-index of the logistic regression model. The c-index can be considered a generalization of the area under the receiver operating characteristic (ROC) curve, and it was used to assess how well the model could discriminate between patients who lived and patients who had died. The performance was moderately predictive (c-index = 0.631, confidence interval 95%, 0.525–0.736).

Therefore the system can be helpful in our particular country to predict the outcomes after acute aortic syndromes, even tough as it may be to require further refinement to be generally applied.

	References

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1. Centofanti P, Flocco R, Ceresa F, et al. Is surgery always mandatory for type A aortic dissection? Ann Thorac Surg 2006;82:1658-1663discussion 1664.[Abstract/Free Full Text]

This article has been cited by other articles:

				P. Centofanti, R. Flocco, F. Ceresa, M. Attisani, M. La Torre, L. Weltert, and A. M. Calafiore Reply Ann. Thorac. Surg., September 1, 2007; 84(3): 1070 - 1071. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jose Luis Vallejo Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lima-Cañadas, P. P. Articles by Diaz de Tuesta, I. Search for Related Content PubMed PubMed Citation Articles by Lima-Cañadas, P. P. Articles by Diaz de Tuesta, I. Related Collections Great vessels Related Article