Prognostic Value of D‐Dimer in Acute Type A Aortic Dissection and Intramural Hematoma: Observations from the Acute Aortic Syndrome Group of the Registry of Acute Non‐Traumatic Chest Pain in China
Background Acute type A aortic dissection (AAD) and acute type A intramural hematoma (AIMH) are life‐threatening conditions with high mortality rates, and prognostic indicators are critical for guiding urgent treatment decisions. We assessed the prognostic significance of admission D‐dimer levels in...
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2025-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| author | Lingyue Qiu Qingwei Ji Huangtai Miao Meiying Long Ming Gong Jing Ye Tianxiao Liu Tianlong Zhang Zhaohe Huang Yan Liu Na Yin Xiaoyan Wu Ying Shi Huayuan Zeng Ling Liu Yingzhong Lin Liwen Lyu Wei Chen Hua Su Guoping Shi Hai Gao Hongjia Zhang |
| author_facet | Lingyue Qiu Qingwei Ji Huangtai Miao Meiying Long Ming Gong Jing Ye Tianxiao Liu Tianlong Zhang Zhaohe Huang Yan Liu Na Yin Xiaoyan Wu Ying Shi Huayuan Zeng Ling Liu Yingzhong Lin Liwen Lyu Wei Chen Hua Su Guoping Shi Hai Gao Hongjia Zhang |
| author_sort | Lingyue Qiu |
| collection | DOAJ |
| description | Background Acute type A aortic dissection (AAD) and acute type A intramural hematoma (AIMH) are life‐threatening conditions with high mortality rates, and prognostic indicators are critical for guiding urgent treatment decisions. We assessed the prognostic significance of admission D‐dimer levels in patients with AAD and AIMH. Methods and Results The prospective, multicenter, observational study in China recruited participants from 2013 to 2019. Patients with AAD and AIMH were respectively categorized into quartiles based on admission D‐dimer levels. Cox regression analysis was used to assess the association between D‐dimer levels and mortality. A total of 3132 patients with AAD (mean age: 50.63 years [SD, 12.56]) and 353 patients with AIMH (mean age: 59.63 years [SD, 11.00]) were included. In patients with AAD, overall mortality rates increased across D‐dimer quartiles: 13.7% (Q1, ≤0.72 mg/L), 16.7% (Q2, 0.72–1.91 mg/L), 22.8% (Q3, 1.91–4.21 mg/L), and 28.5% (Q4, 4.21–20.00 mg/L). In patients with AIMH, mortality rates by quartile were 3.4% (Q1, ≤0.51 mg/L), 5.7% (Q2, 0.51–1.25 mg/L), 4.6% (Q3, 1.25–3.44 mg/L), and 10.2% (Q4, 3.44–20.00 mg/L). After adjusting for confounders, D‐dimer was an independent predictor of overall mortality (hazard ratio [HR], 1.42 [95% CI, 1.11–1.80]) and in‐hospital mortality (HR, 1.47 [95% CI, 1.13–1.92]) in patients with AAD. D‐dimer levels were not significantly associated with the overall (HR, 2.61 [95% CI, 0.70–9.73]) or in‐hospital mortality (HR, 1.78 [95% CI, 0.44–7.24]) of patients with AIMH by multivariable adjustment. Conclusions Elevated admission D‐dimer levels are independently associated with higher mortality in patients with AAD but are not significantly associated with prognosis in patients with AIMH. Our findings suggest that D‐dimer may serve as a useful prognostic marker in patients with AAD. Registration www.chictr.org.cn. Unique identifier: ChiCTR230006854. |
| format | Article |
| id | doaj-art-9b8d19c402b4411cbe42536f1b4ea8f5 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-01-01 |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-9b8d19c402b4411cbe42536f1b4ea8f52025-08-20T02:34:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-01-0114210.1161/JAHA.124.036843Prognostic Value of D‐Dimer in Acute Type A Aortic Dissection and Intramural Hematoma: Observations from the Acute Aortic Syndrome Group of the Registry of Acute Non‐Traumatic Chest Pain in ChinaLingyue Qiu0Qingwei Ji1Huangtai Miao2Meiying Long3Ming Gong4Jing Ye5Tianxiao Liu6Tianlong Zhang7Zhaohe Huang8Yan Liu9Na Yin10Xiaoyan Wu11Ying Shi12Huayuan Zeng13Ling Liu14Yingzhong Lin15Liwen Lyu16Wei Chen17Hua Su18Guoping Shi19Hai Gao20Hongjia Zhang21Guangxi Chest Pain Center, and Department of Cardiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, and Institute of Cardiovascular Diseases, Guangxi Academy of Medical Sciences Nanning ChinaGuangxi Chest Pain Center, and Department of Cardiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, and Institute of Cardiovascular Diseases, Guangxi Academy of Medical Sciences Nanning ChinaChest Pain Center, and Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, and Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing ChinaGuangxi Chest Pain Center, and Department of Cardiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, and Institute of Cardiovascular Diseases, Guangxi Academy of Medical Sciences Nanning ChinaDepartment of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, and The Key Laboratory of Cardiovascular Remodeling‐related Diseases, Ministry of Education, and Beijing Institute of Heart Lung and Blood Vessel Disease Beijing ChinaChest Pain Center, and Department of Cardiology Renmin Hospital of Wuhan University Wuhan Hubei ChinaGuangdong Provincial Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences Guangzhou ChinaChest Pain Center, Beijing Chaoyang Integrative Medicine Rescue and First Aid Hospital Beijing ChinaChest Pain Center, and Department of Cardiology Affiliated Hospital of Youjiang Medical University for Nationalities Beijing ChinaChest Pain Center, and Department of Cardiology Affiliated Hospital of Youjiang Medical University for Nationalities Beijing ChinaChest Pain Center, and Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, and Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing ChinaChest Pain Center, and Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, and Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing ChinaGuangxi Chest Pain Center, and Department of Cardiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, and Institute of Cardiovascular Diseases, Guangxi Academy of Medical Sciences Nanning ChinaGuangxi Chest Pain Center, and Department of Cardiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, and Institute of Cardiovascular Diseases, Guangxi Academy of Medical Sciences Nanning ChinaGuangxi Chest Pain Center, and Department of Cardiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, and Institute of Cardiovascular Diseases, Guangxi Academy of Medical Sciences Nanning ChinaGuangxi Chest Pain Center, and Department of Cardiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, and Institute of Cardiovascular Diseases, Guangxi Academy of Medical Sciences Nanning ChinaGuangxi Chest Pain Center, and Department of Emergency the People’s Hospital of Guangxi Zhuang Autonomous Region and Research Center of Cardiovascular Disease, Guangxi Academy of Medical Sciences Nanning ChinaChest Pain Center, and Heart Center, Guilin People’s Hospital Guilin ChinaChest Pain Center, and Department of Cardiology Hezhou People’s Hospital Hezhou ChinaDepartment of Medicine Brigham and Women’s Hospital and Harvard Medical School Boston MA USAChest Pain Center, and Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, and Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing ChinaDepartment of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, and The Key Laboratory of Cardiovascular Remodeling‐related Diseases, Ministry of Education, and Beijing Institute of Heart Lung and Blood Vessel Disease Beijing ChinaBackground Acute type A aortic dissection (AAD) and acute type A intramural hematoma (AIMH) are life‐threatening conditions with high mortality rates, and prognostic indicators are critical for guiding urgent treatment decisions. We assessed the prognostic significance of admission D‐dimer levels in patients with AAD and AIMH. Methods and Results The prospective, multicenter, observational study in China recruited participants from 2013 to 2019. Patients with AAD and AIMH were respectively categorized into quartiles based on admission D‐dimer levels. Cox regression analysis was used to assess the association between D‐dimer levels and mortality. A total of 3132 patients with AAD (mean age: 50.63 years [SD, 12.56]) and 353 patients with AIMH (mean age: 59.63 years [SD, 11.00]) were included. In patients with AAD, overall mortality rates increased across D‐dimer quartiles: 13.7% (Q1, ≤0.72 mg/L), 16.7% (Q2, 0.72–1.91 mg/L), 22.8% (Q3, 1.91–4.21 mg/L), and 28.5% (Q4, 4.21–20.00 mg/L). In patients with AIMH, mortality rates by quartile were 3.4% (Q1, ≤0.51 mg/L), 5.7% (Q2, 0.51–1.25 mg/L), 4.6% (Q3, 1.25–3.44 mg/L), and 10.2% (Q4, 3.44–20.00 mg/L). After adjusting for confounders, D‐dimer was an independent predictor of overall mortality (hazard ratio [HR], 1.42 [95% CI, 1.11–1.80]) and in‐hospital mortality (HR, 1.47 [95% CI, 1.13–1.92]) in patients with AAD. D‐dimer levels were not significantly associated with the overall (HR, 2.61 [95% CI, 0.70–9.73]) or in‐hospital mortality (HR, 1.78 [95% CI, 0.44–7.24]) of patients with AIMH by multivariable adjustment. Conclusions Elevated admission D‐dimer levels are independently associated with higher mortality in patients with AAD but are not significantly associated with prognosis in patients with AIMH. Our findings suggest that D‐dimer may serve as a useful prognostic marker in patients with AAD. Registration www.chictr.org.cn. Unique identifier: ChiCTR230006854.https://www.ahajournals.org/doi/10.1161/JAHA.124.036843acute type A aortic dissectionacute type A intramural hematomaD‐dimermortalityprognosis |
| spellingShingle | Lingyue Qiu Qingwei Ji Huangtai Miao Meiying Long Ming Gong Jing Ye Tianxiao Liu Tianlong Zhang Zhaohe Huang Yan Liu Na Yin Xiaoyan Wu Ying Shi Huayuan Zeng Ling Liu Yingzhong Lin Liwen Lyu Wei Chen Hua Su Guoping Shi Hai Gao Hongjia Zhang Prognostic Value of D‐Dimer in Acute Type A Aortic Dissection and Intramural Hematoma: Observations from the Acute Aortic Syndrome Group of the Registry of Acute Non‐Traumatic Chest Pain in China Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute type A aortic dissection acute type A intramural hematoma D‐dimer mortality prognosis |
| title | Prognostic Value of D‐Dimer in Acute Type A Aortic Dissection and Intramural Hematoma: Observations from the Acute Aortic Syndrome Group of the Registry of Acute Non‐Traumatic Chest Pain in China |
| title_full | Prognostic Value of D‐Dimer in Acute Type A Aortic Dissection and Intramural Hematoma: Observations from the Acute Aortic Syndrome Group of the Registry of Acute Non‐Traumatic Chest Pain in China |
| title_fullStr | Prognostic Value of D‐Dimer in Acute Type A Aortic Dissection and Intramural Hematoma: Observations from the Acute Aortic Syndrome Group of the Registry of Acute Non‐Traumatic Chest Pain in China |
| title_full_unstemmed | Prognostic Value of D‐Dimer in Acute Type A Aortic Dissection and Intramural Hematoma: Observations from the Acute Aortic Syndrome Group of the Registry of Acute Non‐Traumatic Chest Pain in China |
| title_short | Prognostic Value of D‐Dimer in Acute Type A Aortic Dissection and Intramural Hematoma: Observations from the Acute Aortic Syndrome Group of the Registry of Acute Non‐Traumatic Chest Pain in China |
| title_sort | prognostic value of d dimer in acute type a aortic dissection and intramural hematoma observations from the acute aortic syndrome group of the registry of acute non traumatic chest pain in china |
| topic | acute type A aortic dissection acute type A intramural hematoma D‐dimer mortality prognosis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.036843 |
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