Performance and costs of rule-out protocols for acute aortic syndromes: analysis of pooled prospective cohorts

• DOI: 10.1016/j.ejim.2025.03.039
• Publication Date: 2025-04-11T19:20:03Z
• Authors: Paolo Bima; Peiman Nazerian; Christian Mueller; Matteo Castelli; Elisa Capretti; Alexandre de Mato...; Alessandro Cipriano; Giorgio Costantino; Simone Vanni; Bernd A. Leidel; Beat A. Kaufmann; Adi Osman; Marcello Candelli; Nicolò Capsoni; Wilhelm Behringer; Giovanni Ascione; Tatiana de Carval...; Lorenzo Ghiadoni; Emanuele Pivetta; Enrico Lupia; Fulvio Morello
• Keywords: Acute aortic syndrome

Acute aortic syndromes (AAS) are deadly conditions causing unspecific symptoms, such as chest/abdominal/back pain, syncope and neurological deficit. They diagnosed with computed tomography angiography (CTA), but the patient selection is challenging. To support physicians standardize management, protocols combining a clinical score D-dimer (DD) have been developed. However, direct comparison of their diagnostic performance cost-effectiveness lacking. We used individual data from 3 prospective studies patients suspected AAS, enrolled in 12 centers 5 countries. Diagnostic accuracy, failure rate costs were calculated for protocols, applying scores (aortic dissection detection [ADD], AORTAs Canadian) 2 DD thresholds (500 ng/mL [DD500], age-adjusted [DDage]). Costs estimated using Italian German reimbursements. Among 4907 patients, 506 (10.3 %) had an AAS. The sensitivity ranged 97.6 % Canadian/DD500 to 99.4 AORTAs/DD500 or DDage (P = 0.022). specificity was lowest (46.8 %; P < 0.001 vs AORTAs/DD500) highest ADD/DDage (61.5 0.001). number potential AAS misses 4-fold higher DDage. net benefit ADD/DDage. All reduced CTA exams over CTA-to-all strategy. Numbers predicted per 100 (447 CTAs, 34,366 EUR) (579 43,628 AORTAs/DD500. Guideline-compliant score/DD based highly sensitive. Differences efficiency present. Data may guide decision-making on policies resources.