Diagnostic accuracy of the aortic dissection detection risk score plus D-dimer for acute aortic syndromes

Abstract

Objective To assess the safety and efficiency of such diagnostic strategy of aortic dissection score combined D-dimer for acute aortic syndromes (AAS). Methods In a multicenter prospective observational study involving 3 hospitals from 2014 to 2017, 3330 patients were analyzed. Among them, 2132 were males and 1198 were females, aged from 50 to 72 years, with an average age of (52.68±4.9) years. The tool for PPA was the aortic dissection detection risk score (ADD-RS) per current guidelines. DD was considered negative (DD-) if >0.5 cu/mL. Final case adjudication was based on conclusive diagnostic imaging, autopsy, surgery or on 14-day follow-up. The outcomes were the failure rate and efficiency of a diagnostic strategy ruling-out AAS in patients with ADD-RS=0/DD- or ADD-RS≤D/DD-. Results 766 (23%) patients had ADD-RS=0, 1732 (52%) patients had ADD-RS=1, and 832 (25%) had ADD-RS>1. 434 (13%) patients had AAS. A positive DD test result had an overall sensitivity of 95.2% (95% CI 92.7-97%) and a specificity of 62% (95% CI 60.3-64.1%) for diagnosis of AAS; 17 patients with AAS had DD-. Within 529 patients with ADD-RS=0/DD-, 2 cases of AAS were observed. This yielded a failure rate of 0.4% (95% CI 0.1-1.9%) and efficiency of 15.3% (95% CI 14.6-17.2%) for the ADD-RS=0/DD- strategy. Within 1 663 patients with ADD-RS ≤s/DD-, 6 cases of AAS were observed. This yielded a failure rate of 0.4% (95% CI 0.2-1.1%) and efficiency of 51.2% (95% CI 48.1-53.6%) for the ADD-RS≤f/DD- strategy. Conclusions Integration of ADD-RS (both =0 or ≤o)with DD may be considered to standardize diagnostic rule-out of AAS. Key words: Aortic dissection; Aortic disease; Diagnosis; Risk score; D-dimer