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Evaluation of D-dimer in the diagnosis of suspected aortic dissection

Abstract Background: The goal of this study was to evaluate plasma D-dimer as a diagnostic marker for exclusion of suspected aortic dissection (AD). Methods: Two-hundred and sixty suspected AD patients were enrolled, including acute AD, n=107; chronic AD, n=17; acute myocardial infarction (AMI), n=70; pulmonary embolism (PE), n=18; non-ST elevation myocardial infarction (NSTEMI), n=28; and unstable angina (UA), n=20. All patients had D-dimer testing performed (Roche Diagnostics GmbH) immediately following admission. Results: The D-dimer concentrations in both the acute AD group [median: 3.47; 95% confidence interval (CI): 2.43–4.50 μg/mL] and chronic AD group (median: 1.09; 95% CI: 0.36–3.81 μg/mL) were significantly higher than those in patients in the AMI, NSTEMI and UA groups (p=0.000), but not when compared to the PE group. One (0.8%) patient was identified in the acute AD group who presented with a low D-dimer value (0.04 μg/mL), indicating the existence of intramural hematoma as demonstrated by CT. Conclusions: D-dimer may be used as a potential marker for suspected AD, with high sensitivity of up to 99.2% (1/124). Regardless of the cut-off threshold selected, the sensitivity of D-dimer was unable to reach 100%. Further examinations, including imaging technology, were necessary to diagnose the suspected AD patients who had negative D-dimer result. Clin Chem Lab Med 2010;48:1733–7.