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(Circulation. 2009;119:2702-2707.)
© 2009 American Heart Association, Inc.

Vascular Medicine

Diagnosis of Acute Aortic Dissection by D-Dimer

The International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) Experience

Toru Suzuki, MD; Alessandro Distante, MD; Antonella Zizza, MS; Santi Trimarchi, MD; Massimo Villani, MD; Jorge Antonio Salerno Uriarte, MD; Luigi De Luca Tupputi Schinosa, MD; Attilio Renzulli, MD; Federico Sabino, MD; Richard Nowak, MD; Robert Birkhahn, MD; Judd E. Hollander, MD; Francis Counselman, MD; Ravi Vijayendran, PhD; Eduardo Bossone, MD; Kim Eagle, MD, for the IRAD-Bio Investigators

From the University of Tokyo, Tokyo, Japan (T.S.); Istituto Scientifico Biomedico Euro Mediterraneo, Brindisi, Institute of Clinical Physiology, National Research Council, Lecce, and University Medical School, Pisa, Italy (A.D.); Institute of Clinical Physiology, National Research Council, Lecce, Italy (A.Z.); IRCCS Policlinico San Donato, Milan, Italy (S.T.); Vito Fazzi Hospital, Lecce, Italy (M.V.); Universita degli studi dell'Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy (J.A.S.U.); Policlinico Hospital, Bari, Italy (L.D.L.T.S.); UMG, Catanzaro, Italy (A.R.); ALIV Healthcare R&D, Forte dei Marmi, Italy (F.S.); Henry Ford Hospital, Detroit, Mich (R.N.); New York Methodist Hospital, Brooklyn (R.B.); University of Pennsylvania, Philadelphia (J.E.H.); Eastern Virginia Medical School, Norfolk (F.C.); Biosite, San Diego, Calif (R.V.); National Research Council, Lecce, Italy (E.B.); and University of Michigan, Ann Arbor (K.E.).

Correspondence to Toru Suzuki, MD, Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, 7–3–1 Hongo, Bunkyo-ku, Tokyo 113–8655 Japan. E-mail torusuzu-tky{at}umin.ac.jp

Received October 31, 2008; accepted March 24, 2009.

Background— 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.

Methods and Results— 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.

Conclusion— 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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CLINICAL PERSPECTIVE

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Clinical Summaries
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