Diagnosis of acute aortic dissection by D-dimer: the International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience.
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.


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.


CONCLUSIONS
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.
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 Japan. torusuzu-tky@umin.ac.jp
Toru
T
Suzuki
Alessandro
A
Distante
Antonella
A
Zizza
Santi
S
Trimarchi
Massimo
M
Villani
Jorge Antonio
JA
Salerno Uriarte
Luigi
L
De Luca Tupputi Schinosa
Attilio
A
Renzulli
Federico
F
Sabino
Richard
R
Nowak
Robert
R
Birkhahn
Judd E
JE
Hollander
Francis
F
Counselman
Ravi
R
Vijayendran
Eduardo
E
Bossone
Kim
K
Eagle
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis*; D015415:Biomarkers; D003935:Diagnostic Techniques, Cardiovascular / Q000592:standards*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012042:Registries; D055815:Young Adult
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D