Acute type A aortic dissection is a relatively uncommon, although potentially life threatening, disease. Given the high mortality, predictive tools to identify patients at increased risk of death are needed to assist clinicians in optimal treatment. Known prognostic parameters are: age > 70 years; abrupt onset of chest pain; hypotension, shock, or tamponade; renal failure at presentation; pulse deficit; and abnormal ECG, particularly ST segment elevation.¹

Recently we found that concentrations of D-dimer, a degradation product of cross linked fibrin, were raised in all cases of acute aortic dissection and, therefore, normal D-dimer concentrations can be used to rule out the disease.² Our results were subsequently confirmed by others.³ However, owing to small patient numbers in both studies, no firm conclusions about the prognostic significance of absolute D-dimer concentrations can be drawn.

METHODS

We measured plasma concentrations of D-dimer in 27 patients with acute type A dissection of the …