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      Admission D-dimer testing for differentiating acute aortic dissection from other causes of acute chest pain

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          Abstract

          Introduction

          The present study aims to evaluate the utility of D-dimer testing for differentiating the causes of acute chest pain, including acute aortic dissection (AAD), pulmonary embolism (PE), acute myocardial infarction (AMI), unstable angina (UA), and other uncertain diagnoses of chest pain.

          Material and methods

          Consecutive patients admitted for acute chest pain within 24 h from symptom onset were enrolled prospectively, and plasma D-dimer levels were measured on admission. Diagnoses of AAD, PE, AMI, and UA were confirmed by standard methods.

          Results

          A total of 790 patients were enrolled, including 202 AAD, 43 PE, 315 AMI, 136 UA, and 94 cases of other uncertain diagnoses. D-dimer levels were significantly higher in patients with AAD and PE than in those with AMI, UA, and other uncertain diagnoses ( p < 0.001), but they were comparable between patients with AAD and PE ( p = 0.065). Moreover, patients with type A AAD had higher D-dimer levels than those with type B AAD ( p = 0.022). Receiver operating characteristic (ROC) curve analysis showed that a D-dimer level < 0.5 µg/ml was a good predictor for ruling out AAD, with a sensitivity of 94.0% and a specificity of 56.8%. At a cut-off level of 0.5 µg/ml, the negative and positive likelihood ratios were 0.10 and 2.18, respectively, with a positive predictive value of 42.6% and a negative predictive value of 96.6%.

          Conclusions

          The D-dimer level within 24 h after symptom onset might be helpful for differentiating AAD from other causes of chest pain.

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          Most cited references32

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          Diagnosis and management of aortic dissection.

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

            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. 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. 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.
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              Dissecting aneurysm of the aorta: a review of 505 cases.

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                Author and article information

                Journal
                Arch Med Sci
                Arch Med Sci
                AMS
                Archives of Medical Science : AMS
                Termedia Publishing House
                1734-1922
                1896-9151
                20 April 2017
                01 April 2017
                : 13
                : 3
                : 591-596
                Affiliations
                [1 ]State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
                [2 ]Emergency and Critical Care Center of Cardiovascular Department, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
                Author notes
                Corresponding authors: Xiaohan Fan, Rutai Hui, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China. Phone: +86 10-88398154, +86 10-88398154, Fax: +86 10-68331730, +86 10-68331730. E-mail: fanxiaohan@ 123456fuwaihospital.org
                Article
                29828
                10.5114/aoms.2017.67280
                5420634
                28507573
                f10fbffa-7f3e-42bc-b447-f529a3b1590a
                Copyright: © 2017 Termedia & Banach

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

                History
                : 14 November 2014
                : 08 March 2015
                Categories
                Clinical Research

                Medicine
                pulmonary embolism,acute myocardial infarction,unstable angina,chest pain
                Medicine
                pulmonary embolism, acute myocardial infarction, unstable angina, chest pain

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