Riccardo Gorla1,2, Raimund Erbel1, Philipp Kahlert1, Konstantinos Tsagakis3, Heinz Jakob3, Amir-Abbas Mahabadi1, Thomas Schlosser4, Holger Eggebrecht5, Eduardo Bossone6, Rolf Alexander Jánosi1. 1. 1 Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany. 2. 2 University of Insubria, Varese, Italy. 3. 3 Department of Thoracic and Cardiovascular surgery, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany. 4. 4 Department of Radiology, University Hospital Essen and University Duisburg-Essen, Germany. 5. 5 Cardioangiological Center Bethanien, Germany. 6. 6 'Heart' Department, University Hospital Salerno, Italy.
Abstract
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.
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.
Authors: Carlos Ferrera; Isidre Vilacosta; Beatriz Cabeza; Javier Cobiella; Isaac Martínez; Melchor Saiz-Pardo Sanz; Ana Bustos; Francisco Javier Serrano; Luis Maroto Journal: Vasc Health Risk Manag Date: 2020-06-08