Clinical Prediction of Acute Aortic Dissection

Abstract

ACUTE AORTIC dissection is the most frequently fatal condition in the spectrum of chest pain syndromes.^1,2 With undelayed diagnosis and optimal medical and surgical therapy, however, 30-day survival can exceed 90%.^1-4 Noninvasive imaging modalities permit rapid and safe diagnosis of dissection even in the early stage of intramural hematoma.^3,4 With poorly defined criteria for imaging of the aorta, however, 35% of dissections are not subjected to imaging,^5,6 and more than 99% of suspected dissections can finally be refuted.^7-9 The attempt of the American College of Emergency Physicians to define a policy for the initial approach to patients with chest pain recently highlighted the continuing need for clinical criteria for aortic dissection.^10-12 To define predictors of dissection we analyzed 26 clinical variables in a prospective, observational study of 250 study patients before emergency imaging of the aorta. The analysis was intended to design a simple prediction model for more rapid estimation of the individual risk of dissection on arrival in the emergency department. Such models have been developed to improve coronary care unit admission practices in ischemic heart disease and might also permit better selection for prompt diagnostic imaging with improved survival after dissection.¹³