title: Accuracy of a diagnostic strategy combining aortic dissection detection risk score and D-dimer levels in patients with suspected acute aortic syndrome.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.|2 University of Insubria, Varese, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gorla
authors.affiliation: 1 Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.affiliation: 1 Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kahlert
authors.affiliation: 3 Department of Thoracic and Cardiovascular surgery, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsagakis
authors.affiliation: 3 Department of Thoracic and Cardiovascular surgery, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.affiliation: 1 Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.
authors.forename: Amir-Abbas
authors.initials: AA
authors.lastname: Mahabadi
authors.affiliation: 4 Department of Radiology, University Hospital Essen and University Duisburg-Essen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schlosser
authors.affiliation: 5 Cardioangiological Center Bethanien, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.affiliation: 6 'Heart' Department, University Hospital Salerno, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.affiliation: 1 Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.
authors.forename: Rolf Alexander
authors.initials: RA
authors.lastname: Jánosi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000465:Algorithms; D000784:Aortic Dissection / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D001014:Aortic Aneurysm / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011379:Prognosis; D055503:Protein Multimerization; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013577:Syndrome
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-dimer; acute aortic dissection; acute aortic syndrome; aortic dissection detection risk score; emergency department