Accuracy of a diagnostic strategy combining aortic dissection detection risk score and D-dimer levels in patients with suspected acute aortic syndrome.

Abstract

The European Society of Cardiology recently proposed a novel diagnostic algorithm combining the aortic dissection detection (ADD) risk score with D-dimer level assessment for detecting acute aortic syndromes (AASs) in patients presenting with chest pain. The diagnostic accuracy of this strategy is yet to be validated. We retrospectively identified 376 patients with chest pain and available D-dimer on admission to the emergency department of our institution between January 2011 and May 2014. The ADD risk score was calculated using retrospective blinded chart review. A score ⩽1 was defined as 'low probability', whereas a score >1 as 'high probability'. AASs were diagnosed in 85 (22.6%) patients. Patients with AAS more frequently had a 'high probability' score than AAS-negative patients (63.5% vs 1.0%; P<0.001). An ADD risk score ⩾1 had a sensitivity of 98.8% and a specificity of 64.6% for diagnosing AAS with a failure rate of 0.5%, whereas an ADD risk score ⩾2 had a sensitivity of 63.5% and a specificity of 98.9% with a failure rate of 9.7%. Among the patients with a 'low probability' score, D-dimer had a sensitivity and specificity for the detection of AAS, respectively, of 93.5% and 63.2%, with a negative predictive value of 98.9% and a failure rate of 1.1%. A 'high probability' ADD score detected AAS with good specificity. A 'low probability' score combined with negative D-dimer safely and efficiently ruled out AAS with a low failure rate.