Impact of d -Dimer Levels on Admission on Inhospital and Long-Term Outcome in Patients With Type A Acute Aortic Dissection

• Published in: The American journal of cardiology 2015-06, Vol.115 (11), p.1595-1600
• Main Authors: Huang, Bi, MD, Yang, Yanmin, MD, PhD, Lu, Haisong, BS, Zhao, Zhenhua, BS, Zhang, Shu, MD, Hui, Rutai, MD, PhD, Fan, Xiaohan, MD, PhD
• Format: Article
• Language: English
• Subjects: Acute Disease; Aortic Diseases - blood; Aortic Diseases - classification; Aortic Diseases - mortality; Cardiovascular; Female; Fibrin Fibrinogen Degradation Products - analysis; Hospital Mortality; Humans; Male; Middle Aged; Patient Admission; Predictive Value of Tests; Prospective Studies; Time Factors
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2015.02.067

Limited studies with relatively small sample sizes have reported that elevated d -dimer levels on admission were associated with increased risk of short-term mortality in patients with type A acute aortic dissection (AAD). However, there were unavailable data regarding the impact of admission d -dimer levels on long-term outcomes. Our present study aimed to evaluate the association of admission d -dimer levels with both inhospital and long-term all-cause mortality in patients with type A AAD. A total of 212 consecutive patients with type A AAD were enrolled. d -Dimer levels were measured on admission, and patients were followed up prospectively. The primary end points were inhospital and long-term all-cause mortality. The median length of follow-up was 18.8 months (interquartile range 6.7 to 24.4 months). The inhospital and long-term all-cause mortality rates were 12.7% and 12.4%, respectively. Compared with the survivors, the nonsurvivors had significantly higher d -dimer levels (p 6.10 μg/ml) had the highest inhospital and long-term mortality among groups. After multivariate adjustment, the d -dimer level in Q4 (>6.10 μg/ml) was an independent risk factor for inhospital mortality (hazard ratio [HR] 6.12, 95% confidence interval 1.35 to 27.89, p = 0.019) in addition to surgical treatment; however, this was not an independent predictor for long-term mortality. In conclusion, our study with a relatively large sample size suggested that elevated admission d -dimer levels (>6.10 μg/ml) might be a predictor for increased risk of inhospital mortality, and urgent-emergent surgery might be needed in patients with elevated d -dimer levels on admission. However, d -dimer levels at admission failed to predict long-term mortality.