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Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

2018; Wiley; Volume: 7; Issue: 14 Linguagem: Inglês

10.1161/jaha.118.009144

2047-9980

Ryo Itagaki, Naoyuki Kimura, Makiko Mieno, Daijiro Hori, Satoshi Itoh, Kei Akiyoshi, Koichi Yuri, Keisuke Tanno, Koji Kawahito, Atsushi Yamaguchi,

Cardiac Valve Diseases and Treatments

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.