Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes The ADvISED Prospective Multicenter Study

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art_NAZERIAN_Diagnostic_Accuracy_of_the_Aortic_Dissection_Detection_Risk_2018.PDF (1.84 MB)
Citações na Scopus
171
Tipo de produção
article
Data de publicação
2018
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
LIPPINCOTT WILLIAMS & WILKINS
Autores
NAZERIAN, Peiman
MUELLER, Christian
LEIDEL, Bernd A.
SALVADEO, Sibilla Anna Teresa
GIACHINO, Francesca
VANNI, Simone
GRIMM, Karin
PIVETTA, Emanuele
Citação
CIRCULATION, v.137, n.3, p.250-258, 2018
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
BACKGROUND: Acute aortic syndromes (AASs) are rare and severe cardiovascular emergencies with unspecific symptoms. For AASs, both misdiagnosis and overtesting are key concerns, and standardized diagnostic strategies may help physicians to balance these risks. D-dimer (DD) is highly sensitive for AAS but is inadequate as a stand-alone test. Integration of pretest probability assessment with DD testing is feasible, but the safety and efficiency of such a diagnostic strategy are currently unknown. METHODS: In a multicenter prospective observational study involving 6 hospitals in 4 countries from 2014 to 2016, consecutive outpatients were eligible if they had >= 1 of the following: chest/abdominal/back pain, syncope, perfusion deficit, and if AAS was in the differential diagnosis. The tool for pretest probability assessment was the aortic dissection detection risk score (ADD-RS, 0-3) per current guidelines. DD was considered negative (DD-) if < 500 ng/mL. Final case adjudication was based on conclusive diagnostic imaging, autopsy, surgery, or 14-day follow-up. Outcomes were the failure rate and efficiency of a diagnostic strategy for ruling out AAS in patients with ADD-RS=0/DD-or ADD-RS = 1/DD-. RESULTS: A total of 1850 patients were analyzed. Of these, 438 patients (24%) had ADD-RS=0, 1071 patients (58%) had ADD-RS=1, and 341 patients (18%) had ADD-RS > 1. Two hundred forty-one patients (13%) had AAS: 125 had type A aortic dissection, 53 had type B aortic dissection, 35 had intramural aortic hematoma, 18 had aortic rupture, and 10 had penetrating aortic ulcer. A positive DD test result had an overall sensitivity of 96.7% (95% confidence interval [CI], 93.6-98.6) and a specificity of 64% (95% CI, 61.6-66.4) for the diagnosis of AAS; 8 patients with AAS had DD-. In 294 patients with ADD-RS=0/DD-, 1 case of AAS was observed. This yielded a failure rate of 0.3% (95% CI, 0.1-1.9) and an efficiency of 15.9% (95% CI, 14.3-17.6) for the ADD-RS=0/DD-strategy. In 924 patients with ADD-RS <= 1/DD-, 3 cases of AAS were observed. This yielded a failure rate of 0.3% (95% CI, 0.1-1) and an efficiency of 49.9% (95% CI, 47.7-52.2) for the ADD-RS <= 1/DD-strategy. CONCLUSIONS: Integration of ADD-RS (either ADD-RS=0 or ADD-RS = 1) with DD may be considered to standardize diagnostic rule out of AAS.
Palavras-chave
aorta, dissection, fibrin fragment D, syndrome
URI
https://observatorio.fm.usp.br/handle/OPI/24961
Referências
  1. Asha SE, 2015, ANN EMERG MED, V66, P368, DOI 10.1016/j.annemergmed.2015.02.013
  2. Baez AA, 2017, J CRIT CARE, V37, P56, DOI 10.1016/j.jcrc.2016.08.007
  3. Diercks DB, 2015, ANN EMERG MED, V65, P32, DOI 10.1016/j.annemergmed.2014.11.002
  4. Erbel R, 2014, EUR HEART J, V35, P2873, DOI 10.1093/eurheartj/ehu281
  5. Gorla R, 2017, EUR HEART J-ACUTE CA, V6, P371, DOI 10.1177/2048872615594497
  6. Hansen MS, 2007, AM J CARDIOL, V99, P852, DOI 10.1016/j.amjcard.2006.10.055
  7. Hiratzka LF, 2010, CIRCULATION, V121, pE266, DOI 10.1161/CIR.0b013e3181d4739e
  8. Howard DPJ, 2015, CIRCULATION, V132, P1805, DOI 10.1161/CIRCULATIONAHA.115.016424
  9. Klompas M, 2002, JAMA-J AM MED ASSOC, V287, P2262, DOI 10.1001/jama.287.17.2262
  10. Konstantinides SV, 2014, EUR HEART J, V35, P3033, DOI 10.1093/eurheartj/ehu283
  11. Kurabayashi M, 2011, J CARDIOL, V58, P287, DOI 10.1016/j.jjcc.2011.07.008
  12. Lovy AJ, 2013, AM J EMERG MED, V31, P1546, DOI 10.1016/j.ajem.2013.06.005
  13. Mettler FA, 2008, RADIOLOGY, V248, P254, DOI 10.1148/radiol.2481071451
  14. Nazerian P, 2014, EUR HEART J-ACUTE CA, V3, P373, DOI 10.1177/2048872614527010
  15. Nazerian P, 2014, INT J CARDIOL, V175, P78, DOI 10.1016/j.ijcard.2014.04.257
  16. Olsson C, 2006, CIRCULATION, V114, P2611, DOI 10.1161/CIRCULATIONAHA.106.630400
  17. Owens PL, 2010, ANN EMERG MED, V56, P150, DOI 10.1016/j.annemergmed.2009.11.022
  18. Perrier A, 2005, NEW ENGL J MED, V352, P1760, DOI 10.1056/NEJMoa042905
  19. Righini M, 2014, JAMA-J AM MED ASSOC, V311, P1117, DOI 10.1001/jama.2014.2135
  20. Rogers AM, 2011, CIRCULATION, V123, DOI 10.1161/CIRCULATIONAHA.110.988568
  21. Sarasin FP, 1996, ANN EMERG MED, V28, P278, DOI 10.1016/S0196-0644(96)70026-4
  22. Smith-Bindman R, 2009, ARCH INTERN MED, V169, P2078, DOI 10.1001/archinternmed.2009.427
  23. Sun Z, 2012, J CLIN HYPERTENS, V14, P256, DOI 10.1111/j.1751-7176.2012.00590.x
  24. Suzuki T, 2009, CIRCULATION, V119, P2702, DOI 10.1161/CIRCULATIONAHA.108.833004
  25. van Belle A, 2006, JAMA-J AM MED ASSOC, V295, P172
  26. Watanabe H, 2016, SCI REP-UK, V6, DOI 10.1038/srep26893

Coleções
Artigos e Materiais de Revistas Científicas - HC/InCor