Aim To investigate the risk factors of death after acute Stanford type A aortic dissection (ATAAD) complicated with malperfusion syndrome (MPS). Methods 244 patients with ATAAD complicated with MPS who admitted to Nanchong Central Hospital from June 2020 to June 2023 were selected as the study objects. The postoperative survival of the patients was followed up and they were classified into survival group (156 cases) and death group (88 cases). After propensity score matching (PSM) was applied in 1∶1 matching, there were 54 cases in both groups. Univariate and Logistic regression analysis was performed to analyze the risk factors of postoperative death in patients with ATAAD complicated with MPS. Area under curve (AUC) of receiver operating characteristics (ROC) was used to analyze the prognosis of ATAAD complicated with MPS. The prediction model was established by using the regression equation y=1－1/(1+e－z) and the stability of the model was verified by cross-checking method. Results After matching, compared with the survival group (n＝54), in the death group (n＝54), the proportion of sex (male), the proportion of alcohol consumption, acute physiology and chronic health status Ⅱ (APACHE Ⅱ) score, sequential organ failure (SOFA) score, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total serum bilirubin (TSB), cholinesterase, serum creatinine (SCr), blood urea nitrogen (BUN), N-terminal pro-brain natriuretic peptide (NT-proBNP), D-dimer (D-D), white blood cell (WBC), neutrophile granulocyte (NEU), fibrinogen degradation product (FDP), platelet (PLT), fibrinogen (FIB), C-reactive protein (CRP), hypersensitive troponin, operation time, ICU stay time, ventilator stay time, hospital stay, distal extremity hypoperfusion, renal hypoperfusion were significantly increased (P＜0.05). Logistic analysis displayed that gender (male), history of drinking, NT-proBNP≥271.86 ng/L, D-D≥0.74 mg/L and NEU≥13.06×10⁹ L－1 were independent risk factors in ATAAD patients complicated with MPS for postoperative death (P＜0.05). The combination of NT-proBNP, D-D, gender (male), alcohol drinking history and NEU (referred to as “five factors”) had the highest value in predicting ATAAD patients with MPS. The AUC of its ROC curve was 0.979 (95%CI:0.937～0.984), the sensitivity was 94.3%, and the specificity was 91.8%, which was higher than the independent predictor. The best critical value predicted by the five factors was 5.02. The survival rate of the group ＞5.02 was significantly higher than that of the group ≤5.02. Log Rank test P＜0.01. A prediction model was established based on the important factors of postoperative death in ATAAD patients with MPS. The results showed that the model had good prediction accuracy. Conclusion NT-proBNP≥271.86 ng/L, D-D≥0.74 mg/L, gender (male), history of alcohol consumption, and NEU≥×10⁹ L－1 were independent risk factors for long-term prognosis in patients with ATAAD combined with MPS, and their combined application could effectively increase the accuracy of prognosis assessment.