TY - JOUR
T1 - Diagnosis of acute aortic dissection by D-dimer
T2 - The international registry of acute aortic dissection substudy on biomarkers (IRAD-bio) experience
AU - Suzuki, Toru
AU - Distante, Alessandro
AU - Zizza, Antonella
AU - Trimarchi, Santi
AU - Villani, Massimo
AU - Uriarte, Jorge Antonio Salerno
AU - De Luca Tupputi Schinosa, Luigi
AU - Renzulli, Attilio
AU - Sabino, Federico
AU - Nowak, Richard
AU - Birkhahn, Robert
AU - Hollander, Judd E.
AU - Counselman, Francis
AU - Vijayendran, Ravi
AU - Bossone, Eduardo
AU - Eagle, Kim
PY - 2009/5/26
Y1 - 2009/5/26
N2 - BACKGROUND-: D-dimer has been reported to be elevated in acute aortic dissection. Potential use as a "rule-out" marker has been suggested, but concerns remain given that it is elevated in other acute chest diseases, including pulmonary embolism and ischemic heart disease. We evaluated the diagnostic performance of D-dimer testing in a study population of patients with suspected aortic dissection. METHODS AND RESULTS-: In this prospective multicenter study, 220 patients with initial suspicion of having acute aortic dissection were enrolled, of whom 87 were diagnosed with acute aortic dissection and 133 with other final diagnoses, including myocardial infarction, angina, pulmonary embolism, and other uncertain diagnoses. D-dimer was markedly elevated in patients with acute aortic dissection. Analysis according to control disease, type of dissection, and time course showed that the widely used cutoff level of 500 ng/mL for ruling out pulmonary embolism also can reliably rule out aortic dissection, with a negative likelihood ratio of 0.07 throughout the first 24 hours. CONCLUSION-: D-dimer levels may be useful in risk stratifying patients with suspected aortic dissection to rule out aortic dissection if used within the first 24 hours after symptom onset.
AB - BACKGROUND-: D-dimer has been reported to be elevated in acute aortic dissection. Potential use as a "rule-out" marker has been suggested, but concerns remain given that it is elevated in other acute chest diseases, including pulmonary embolism and ischemic heart disease. We evaluated the diagnostic performance of D-dimer testing in a study population of patients with suspected aortic dissection. METHODS AND RESULTS-: In this prospective multicenter study, 220 patients with initial suspicion of having acute aortic dissection were enrolled, of whom 87 were diagnosed with acute aortic dissection and 133 with other final diagnoses, including myocardial infarction, angina, pulmonary embolism, and other uncertain diagnoses. D-dimer was markedly elevated in patients with acute aortic dissection. Analysis according to control disease, type of dissection, and time course showed that the widely used cutoff level of 500 ng/mL for ruling out pulmonary embolism also can reliably rule out aortic dissection, with a negative likelihood ratio of 0.07 throughout the first 24 hours. CONCLUSION-: D-dimer levels may be useful in risk stratifying patients with suspected aortic dissection to rule out aortic dissection if used within the first 24 hours after symptom onset.
KW - Aorta
KW - Diagnosis
KW - Peripheral vascular disease
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U2 - 10.1161/CIRCULATIONAHA.108.833004
DO - 10.1161/CIRCULATIONAHA.108.833004
M3 - Article
C2 - 19433758
AN - SCOPUS:67249108701
VL - 119
SP - 2702
EP - 2707
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 20
ER -