Admission D-dimer testing for differentiating acute aortic dissection from other causes of acute chest pain.
Admission D-dimer testing for differentiating acute aortic dissection from other causes of acute chest pain.
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DOI：
10.5114/aoms.2017.67280
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发表时间：
2017-04-01
期刊：
影响因子：
--
通讯作者：
Fan X
中科院分区：
文献类型：
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作者：
Li W;Huang B;Tian L;Yang Y;Zhang W;Wang X;Chen J;Sun K;Hui R;Fan X
本研究旨在评价D-二聚体试验在鉴别急性胸痛的病因中的作用，包括急性主动脉夹层(AAD)、肺栓塞(PE)、急性心肌梗死(AMI)、不稳定型心绞痛(UA)以及其他不确定的胸痛诊断。前瞻性研究入选自症状出现后24小时内因急性胸痛入院的患者，并在入院时测定血浆D-二聚体水平。AAD、PE、AMI和UA的诊断均经标准方法证实。入选患者790例，其中AAD 202例，PE 43例，AMI315例，UA 136例，其他不明原因者94例。AAD和PE患者的D-二聚体水平显著高于急性心肌梗死、不稳定型心绞痛和其他不确定诊断的患者(p<；0.001)，但在aAD和PE患者之间具有可比性(p=0.065)。此外，A型患者的D-二聚体水平高于B型患者(p=0.022)。受试者工作特征(ROC)曲线分析显示，D-二聚体水平<0.5µg/ml是排除AAD的良好预测指标，其敏感性为94.0%，特异性为56.8%。以0.5µg/ml为界值，阴性似然比为0.10，阳性似然比为2.18，阳性预测值为42.6%，阴性预测值为96.6%。发病后24小时内的D-二聚体水平有助于AAD与其他原因的胸痛的鉴别。
The present study aims to evaluate the utility of D-dimer testing for differentiating the causes of acute chest pain, including acute aortic dissection (AAD), pulmonary embolism (PE), acute myocardial infarction (AMI), unstable angina (UA), and other uncertain diagnoses of chest pain. Consecutive patients admitted for acute chest pain within 24 h from symptom onset were enrolled prospectively, and plasma D-dimer levels were measured on admission. Diagnoses of AAD, PE, AMI, and UA were confirmed by standard methods. A total of 790 patients were enrolled, including 202 AAD, 43 PE, 315 AMI, 136 UA, and 94 cases of other uncertain diagnoses. D-dimer levels were significantly higher in patients with AAD and PE than in those with AMI, UA, and other uncertain diagnoses (p < 0.001), but they were comparable between patients with AAD and PE (p = 0.065). Moreover, patients with type A AAD had higher D-dimer levels than those with type B AAD (p = 0.022). Receiver operating characteristic (ROC) curve analysis showed that a D-dimer level < 0.5 µg/ml was a good predictor for ruling out AAD, with a sensitivity of 94.0% and a specificity of 56.8%. At a cut-off level of 0.5 µg/ml, the negative and positive likelihood ratios were 0.10 and 2.18, respectively, with a positive predictive value of 42.6% and a negative predictive value of 96.6%. The D-dimer level within 24 h after symptom onset might be helpful for differentiating AAD from other causes of chest pain.
DOI：
10.5114/aoms.2014.40732
发表时间：
2014-02-24
期刊：
Archives of medical science : AMS
影响因子：
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作者：
Gromadziński L;Targoński R;Januszko-Giergielewicz B;Ostrowski P;Pruszczyk P
通讯作者：
Pruszczyk P