Key result
D-dimer testing distinguishes acute aortic dissection from nonspecific chest pain with ~91% sensitivity.
Why the study?
Serum d-dimer levels may be used to exclude acute aortic dissection, but data in American patients are limited.
Can serum d-dimer levels at a cutoff of 500 ng/mL be used to exclude acute aortic dissection in patients presenting to the hospital?
Observational (n=48,902)
Can serum d-dimer levels at a cutoff of 500 ng/mL be used to exclude acute aortic dissection in patients presenting to the hospital?
Absolute Event Rate: 2455% vs 385%
p-value: p=< 0.0001
Serum d-dimer levels are significantly elevated in acute aortic dissection but lack sufficient sensitivity at the 500 ng/mL cutoff to safely exclude the diagnosis in isolation.
D-dimer sensitivity of 91% precludes standalone exclusion of AAD; leaves open its adjunctive role pending prospective validation.
Purpose: Acute aortic dissection (AAD) is a highly fatal disorder if not promptly diagnosed. Some international studies have suggested that serum d-dimer levels may be used to exclude AAD, but data are limited. We sought to confirm that d-dimer levels are elevated in American patients with AAD. Additionally, we sought to estimate the test characteristics of the d-dimer for AAD. Patients and Methods: We performed a retrospective analysis of patients in the Hospital Corporation of America database who arrived at the hospital between 2015 and 2019. We queried the database to find patients who had a diagnosis of AAD or (nonspecific) chest pain, and who also had a d-dimer performed within 24 hours of arrival at the hospital. The median d-dimer was compared in those diagnosed with AAD versus chest pain. We estimated the test characteristics of d-dimer for AAD at the standard cutoff value of 500 ng/mL. Results: In total, 48,902 patients met the criteria for analysis, including 572 with AAD and 48,330 with chest pain. The median d-dimers were 2455 ng/mL and 385 ng/mL for the AAD and chest pain groups, respectively (p < 0.0001). Using a cutoff of 500 ng/mL, the sensitivity of the d-dimer was 91.1% and the specificity was 71.4%. Conclusion: Serum d-dimer values are higher in patients with AAD than in those with nonspecific chest pain. At the standard cutoff of 500 ng/mL, the serum d-dimer has a high sensitivity for AAD, but not high enough that d-dimer levels alone can be used in isolation to exclude AAD.
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Zitek et al. (2022) conducted an observational in Acute aortic dissection or nonspecific chest pain (n=48,902). Acute aortic dissection vs. Nonspecific chest pain was evaluated on Median serum d-dimer level (ng/mL) (p=< 0.0001). Serum d-dimer levels were higher in acute aortic dissection than chest pain (2455 vs 385 ng/mL, p<0.0001), yielding 91.1% sensitivity and 71.4% specificity at a 500 ng/mL cutoff.
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