Chest
Clinical InvestigationsSURGERYD-dimer in Acute Aortic Dissection
Section snippets
Materials and Methods
We prospectively tested d-dimer levels in patients with acute aortic dissection (10 patients). In addition, we identified 54 patients who had received this diagnosis in the previous 5 years in our hospital database. In 14 of these patients, a d-dimer test had been performed for differential diagnosis, and the results of those tests were included in our analysis. Thirty-five consecutive patients who were admitted to our cardiology ICU due to acute chest pain of an origin other than aortic
Patients
Baseline characteristics are shown in Table 1, and dissection types, management, and clinical outcomes in Table 2. The diagnostic procedures were as follows: TTE, 23 patients (96%); TEE, 5 patients (21%); CT scanning, 17 patients (71%); MRI, 4 patients (17%); and angiography, 4 patients (17%). In seven patients with type A dissection, no surgery was performed because of refusal by the surgeon or the patient.
Control Group
The final diagnoses for the 35 consecutive patients with acute chest pain were as
Discussion
Acute dissection is a rare but often catastrophic illness. Early and accurate diagnosis and treatment are crucial for survival. The most common clinical presentation of persons with the disease is severe chest pain.4 Associated clinical criteria like pulse or BP differentials can be helpful in suspecting the diagnosis,5 but they are present only in a minority of patients.6 So, the authors of a multicenter registry6 concluded that a high clinical index of suspicion is necessary for rapid
Conclusion
These data provide evidence that a negative d-dimer test result could be useful in excluding acute thoracic aortic dissection.
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