Accuracy of a diagnostic strategy combining aortic dissection detection risk score and D-dimer levels in patients with suspected acute aortic syndrome

被引：69

作者：

Gorla, Riccardo ^{[1
,2
,3
]}

Erbel, Raimund ^{[1
,2
]}

Kahlert, Philipp ^{[1
,2
]}

Tsagakis, Konstantinos ^{[2
,4
]}

Jakob, Heinz ^{[2
,4
]}

Mahabadi, Amir-Abbas ^{[1
,2
]}

Schlosser, Thomas ^{[2
,5
]}

Eggebrecht, Holger ^{[6
]}

Bossone, Eduardo ^{[7
]}

Janosi, Rolf Alexander ^{[1
,2
]}

机构：

[1] West German Heart & Vasc Ctr Essen, Dept Cardiol, Hufelandstr 55, D-45147 Essen, Germany

[2] Univ Duisburg Essen, Duisburg, Germany

[3] Univ Insubria, Varese, Italy

[4] West German Heart & Vasc Ctr Essen, Dept Thorac & Cardiovasc Surg, Essen, Germany

[5] Univ Hosp Essen, Dept Radiol, Essen, Germany

[6] Cardioangiol Ctr Bethanien, Frankfurt, Germany

[7] Univ Hosp Salerno, Heart Dept, Salerno, Italy

来源：

EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE | 2017年 / 6卷 / 05期

关键词：

D-dimer; aortic dissection detection risk score; acute aortic syndrome; acute aortic dissection; emergency department;

D O I：

10.1177/2048872615594497

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims: 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.

引用

页码：371 / 378

页数：8

共 18 条

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