Predicting acute aortic syndrome using aortic dissection detection risk score, D-dimer, and X-ray

Area of Science:

• Cardiology
• Emergency Medicine
• Radiology

Background:

• Acute aortic syndrome (AAS) is a life-threatening condition with high mortality.
• Previous screening tools like the aortic dissection detection risk score (ADD-RS) and D-dimer (DD) have shown screening failures.
• There is a need for more accurate diagnostic tools for AAS in the emergency department (ED).

Purpose of the Study:

• To investigate the diagnostic efficacy of combining ADD-RS, age-adjusted D-dimer (DDage-adj), and chest radiography findings for AAS.
• To evaluate the impact of this combined strategy on reducing screening failures in ED patients.

Main Methods:

• A single-center retrospective case-control study involving 93 AAS patients and 465 non-AAS chest pain patients.
• Comparison of initial clinical presentations and laboratory findings, including DDage-adj and chest radiography.
• Multivariate logistic regression analysis to identify significant predictors of AAS.

Main Results:

• Age-adjusted DD (DDage-adj) demonstrated 92.5% sensitivity and 76.3% specificity for AAS.
• Positive chest radiography findings showed 89.2% sensitivity and 80.9% specificity.
• In low-risk patients (ADD-RS ≤1), the combination of chest radiography and DDage-adj achieved 100% sensitivity, 67.1% specificity, and a 0% failure rate.

Conclusions:

• The combination of ADD-RS, DDage-adj, and chest radiography significantly lowers the failure rate for AAS exclusion.
• This integrated approach offers a low failure rate (<3%) with a specificity of 67.8% for AAS diagnosis.
• Specific radiographic findings like widened mediastinum, aortic contour widening, and aortic kinking are crucial indicators in AAS diagnosis, particularly in low-risk groups.