Abstract 12583: Sensitivity of the National Thoracic Aortic Disease Guideline Diagnostic Algorithm for Identification of Acute Aortic Dissection at Initial Presentation: Results from the International Registry of Acute Aortic Dissection (IRAD)
Background: In March 2010, the American Heart Association (AHA), American College of Cardiology (ACC), and other societies released new guidelines for the diagnosis and management of patients with thoracic aortic disease (TAD), which identified high-risk historical and examination features to assist in the early detection of acute aortic dissection. The sensitivity of these risk markers has not been studied in a large cohort of patients with known acute dissection.
Objective: Evaluate the sensitivity of 12 clinical risk markers proposed in the new TAD guidelines, both individually and in combination.
Methods: We examined 2538 patients enrolled in the IRAD database from 1996 to 2009. The number of patients with confirmed acute dissection who presented with one or more of 12 proposed clinical risk markers was determined. Analysis of patients not identified by the algorithm was performed to better understand their clinical profile.
Results: Of 2538 patients with acute aortic dissection, 2432 (95.8%) were identified by one or more of 12 proposed clinical risk markers, while 2158 (85%) had at least 2 clinical risk markers present (Table). The most sensitive historical features included: abrupt onset of pain (79.3%), severe intensity of pain (72.7%), and ripping, tearing, or stabbing pain (45.4%). Compared to the patients identified by the algorithm, those 106 not identified (4.2% of total population) more frequently were of non-white race (22.9% vs 12.0%, p=0.02), had a history of diabetes (13.0% vs 5.9%, p=0.006), and presented normotensive (49.4% vs 36.8%, p=0.02), while less frequently presented with chest pain (37.8% vs 77.7%, p<0.001), radiating pain (11.7% vs 38.9%, p<0.001), or with history of prior cardiac surgery (7.5% vs 17.7%, p=0.01).
Conclusions: The clinical risk markers proposed in the 2010 TAD Guidelines are, in combination, highly sensitive for the detection of acute aortic dissection.
- © 2010 by American Heart Association, Inc.