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Precisión diagnóstica de la puntuación de riesgo de detección de disección aórtica más D-dimer para los síndromes

Peiman Nazerian¹, Christian Mueller², Alexandre de Matos Soeiro³

¹Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy (P.N., S.V., S.G.).

|October 15, 2017

Resumen

Una nueva estrategia de diagnóstico que combina la puntuación de riesgo de detección de disección aórtica (ADD-RS) y la prueba de D-dimero (DD) puede descartar con seguridad los síndromes aórticos agudos (AAS). Este enfoque mejora la eficiencia del diagnóstico para los pacientes con dolor en el pecho, reduciendo los riesgos de diagnóstico erróneo y de prueba excesiva.

Área de la Ciencia:

Medicina cardiovascular
Imágenes de diagnóstico
Medicina de emergencia

Sus antecedentes:

Los síndromes aórticos agudos (SAA) son emergencias cardiovasculares raras y graves con síntomas inespecíficos, lo que lleva a preocupaciones sobre el diagnóstico erróneo y las pruebas excesivas.
Se necesitan estrategias de diagnóstico estandarizadas para ayudar a los médicos a manejar los riesgos asociados con el diagnóstico de AAS.
El D-dimer (DD) es sensible al AAS pero insuficiente como ensayo independiente; su integración con la evaluación de la probabilidad de pretest requiere una evaluación adicional de la seguridad y la eficacia.

Objetivo del estudio:

Evaluar la seguridad y la eficacia de una estrategia de diagnóstico que integre la puntuación de riesgo de detección de disección aórtica (ADD-RS) con la prueba de D-dimero (DD) para descartar el SAA.
Determinar la tasa de fracaso y la eficiencia del uso de las estrategias ADD-RS=0/DD- y ADD-RS ≤1/DD- en el diagnóstico del SAA.

Principales métodos:

Un estudio observacional prospectivo multicéntrico en el que participaron 1850 pacientes ambulatorios en 6 hospitales de 4 países (2014-2016).
Los pacientes con sospecha de AAS fueron evaluados mediante la prueba ADD-RS (0-3) y DD (DD- < 500 ng/ ml).
Los resultados incluyeron la tasa de fracaso y la eficiencia de las estrategias de diagnóstico para descartar AAS basadas en resultados específicos de ADD-RS y DD.

Principales resultados:

Se analizaron un total de 1850 pacientes, de los cuales 241 (13%) fueron diagnosticados con SAA.
La estrategia ADD-RS=0/DD tuvo una tasa de fracaso del 0,3% (IC del 95%, 0,1-1,9) y una eficacia del 15,9% (IC del 95%, 14,3-17,6) en 294 pacientes.
La estrategia ADD-RS ≤1/ DD mostró una tasa de fracaso del 0,3% (IC 95%, 0,1-1) y una eficacia del 49,9% (IC 95%, 47,7-52,2) en 924 pacientes.

Conclusiones:

La integración del ADD-RS (ADD-RS=0 o ADD-RS ≤1) con el ensayo DD proporciona un enfoque estandarizado para descartar el AAS.
Esta estrategia combinada demuestra una seguridad aceptable y una eficiencia mejorada en el análisis diagnóstico de AAS sospechosos.

Palabras clave:

la aorta disección Fragmento de fibrina D el síndrome

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