Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration. Issue 14 (17th July 2018)

• Record Type: Journal Article
• Authors: Itagaki, Ryo; Kimura, Naoyuki; Mieno, Makiko; Hori, Daijiro; Itoh, Satoshi; Akiyoshi, Kei; Yuri, Koichi; Tanno, Keisuke; Kawahito, Koji; Yamaguchi, Atsushi
• Is Part Of: Journal of the American Heart Association. Volume 7:Issue 14(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-07-17
• Subjects: aortic dissection -- D‐dimer -- false lumen; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.118.009144
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : Background: Clinical characteristics and treatment outcomes of acute type A aortic dissection with D‐dimer elevation have not been clarified. Methods and Results: D‐dimer was measured preoperatively within 24 hours of symptom onset in 262 patients with acute type A aortic dissection. The median (and interquartile range) admission D‐dimer concentration in our total patient group was 26.7 (8.3–85.9) μg/mL. Median (interquartile range) D‐dimer concentrations were 5.0 (2.6–18.0) μg/mL for complete false lumen thrombosis (n=33), 60.9 (19.4–160.4) μg/mL for partial thrombosis (n=81), 26.5 (10.0–70.6) μg/mL for a patent false lumen (n=131), and 8.7 (3.2–26.9) μg/mL for ulcerlike projection (n=17) ( P< 0.01). With a D‐dimer concentration of ≤8.3 μg/mL representing the lower quartile, we then investigated predictors of a low D‐dimer level. Multivariate analysis showed dissection limited to the ascending aorta ( P< 0.01; odds ratio, 9.81) or descending aorta ( P< 0.01; odds ratio, 7.68), a completely thrombosed false lumen ( P< 0.01; odds ratio, 4.02), and absence of brain ischemia ( P= 0.013; odds ratio, 4.74) to be predictors of the lower D‐dimer concentration. Compared with patients with a low D‐dimer concentration (≤8.3 μg/mL, n=66), patients with a D‐dimer concentration >8.3 μg/mL (n=196) had a reduced preoperative platelet count and increased operation time and transfusion volume. In‐hospital mortality was elevated in this group (1.5% versus 11.2%; P= 0.031), although 7‐year survival did not differ for hospital survivors (lower versus higher, 93.1% versus 79.1%; P =0.21). Conclusions: D‐dimer concentrations are strongly influenced by the extent of dissection and false lumen status. Operative risks are increased in patients with a relatively high D‐dimer concentration.