P6021Rule-out of acute aortic syndrome by integration of the aortic dissection detection risk score plus d-dimer: preliminary data from the ADvISED prospective multicenter study

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Background: Acute aortic syndromes (AAS), including aortic dissection, intramural hematoma, penetrating ulcer and aortic rupture, are diagnostic challenges, because they are rare and their presentation is unspecific. Computed tomography angiography (CTA) can accurately diagnose AAS, but patient selection is mandatory. D-dimer (DD) is highly sensitive for AAS, but is inadequate as a stand-alone test. Integration of standardized probability assessment (PA) with DD, as in the approach to pulmonary embolism, is feasible but requires prospective evaluation. Purpose: To assess safety and efficiency of integrating standardized PA with DD for rule-out of AAS. Methods: This was 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 differential diagnosis. Data was collected during the visit, followed by DD testing. The tool for PA was the aortic dissection detection risk score (ADD-RS) endorsed by the ESC. The ADD-RS includes 12 risk factors classified in 3 categories and is calculated as the number of categories (0–3) with ≥1 risk factor. DD was considered positive if >500 ng/ml. The attending physician decided whether to proceed with aortic imaging (AI). All patients not subjected to AI entered a 14-day follow-up for case adjudication. AAS was defined by evidence of AAS on AI, surgery or autopsy, during the evaluation or follow-up. The primary AI was CTA. The main outcomes were failure rate and efficiency of a rule-out strategy based on ADD-RS<1/DD- or ADD-RS<2/DD-.

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