Combined use of aortic dissection detection risk score and D-dimer in the diagnostic workup of suspected acute aortic dissection

Abstract

BackgroundAcute aortic dissection (AD) represents a diagnostic conundrum. Validated algorithms are particularly needed to identify patients where AD could be ruled out without aortic imaging. We evaluated the diagnostic accuracy of a strategy combining the aortic dissection detection (ADD) risk score with D-dimer, a sensitive biomarker of AD. MethodsPatients from two clinical centers with suspected AD were prospectively enrolled in a registry, from January 2008 to March 2013. The ADD risk score was calculated by retrospective blinded chart review. For D-dimer, a cutoff of 500ng/ml was applied. ResultsAD was diagnosed in 233 of 1035 (22.5%) patients. The ADD risk score was 0 in 322 (31.1%), 1 in 508 (49.1%) and >1 in 205 (19.8%) patients. The sensitivity and the failure rate of D-dimer were 100% and 0% in patients with ADD score 0, versus 97.5% (95% CI 91.4–99.6%) and 4.2% (95% CI 0.7–12.5%) in patients with ADD risk score >1. In patients with ADD risk score ≤1, the sensitivity and the failure rate of D-dimer were 98.7% (95% CI 95.3–99.8%) and 0.8% (95% CI 0.1–2.6%). The diagnostic efficiency of D-dimer in patients with ADD risk score 0 and ≤1 was 8.9% (95% CI 7.2–10.7%) and 23.6% (95% CI 21.1–26.2%) respectively. ConclusionsIn a large cohort of patients with suspected AD, the presence of ADD risk score 0 or ≤1 combined with a negative D-dimer accurately and efficiently ruled out AD.