Abstract
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.