Diagnostic and prognostic value of circulating D-Dimers in patients with acute aortic dissection

OBJECTIVE:We sought to determine whether assessing D-Dimer might be helpful for the management of acute aortic dissection (AAD). DESIGN:Single-center retrospective case-control study. SETTING:University Hospital of Strasbourg France. PATIENTS:Patients were 94 consecutive patients admitted to our institution with confirmed AAD and in whom D-Dimer test had been performed at presentation. These patients were matched with 94 controls presenting with clinical suspicion of dissection, which was later ruled out. INTERVENTIONS:Patient characteristics and clinical course were analyzed. MEASUREMENTS AND MAIN RESULTS:Ninety-three (99%) patients with AAD had elevated D-Dimer (>400 ng/mL) with a median D-Dimer value of 8610 ng/mL (interquartile range, 2982–20,000 ng/mL). Receiver operating characteristic curves analysis showed that D-Dimer, but not C-reactive protein, troponin, lactate dehydrogenase, or leukocyte count, was predictive of a diagnosis of AAD, with a sensitivity and specificity of 99% and 34%, respectively. D-Dimer concentration positively correlated with the anatomical extension of the dissection to the different segments of the aorta (R = .47, p < .0001). A positive relationship was observed between D-Dimer and in-hospital mortality rate among patients with AAD (p = .037). On multivariate analysis, the independent predictors of in-hospital mortality were the presence of pericardial effusion (odds ratio, 6.80; confidence interval, 1.87–27.60), D-Dimer >5200 ng/mL (odds ratio, 5.38; confidence interval, 1.27–30.87), and female gender (odds ratio, 4.96; confidence interval, 1.39–19.95). CONCLUSIONS:D-Dimers are elevated in patients with AAD and provide valuable diagnostic and prognostic information. In patients with acute chest pain and elevated D-Dimer, a diagnosis of AAD should also be considered. D-Dimer might be a useful complementary tool to the current diagnostic work-up of patients with suspected AAD.