cute aortic dissection (AAD) results in high mortality and morbidity if it is not recognized and treated promptly, 1 so rapid and accurate diagnosis is essential. 2,3 Needless to say, advanced image modalities, such as computed tomography (CT), magnetic resonance imaging and transesophageal echocardiography, are intrinsic to the accurate diagnosis and treatment of AAD, 2,4 but a simple laboratory test that can suggest the presence of AAD would also be useful, particularly in the emergency setting because it could support the use of advanced imaging. 5,6 Previous reports indicate that D-dimer testing (DT) for AAD has a sensitivity of 100% when the cut off value for D-dimer is set to the upper limit of the normal range, 5-8 indicating that we could exclude AAD if DT was negative. However, each of those study groups comprised small populations of less than 30 patients.The aim of this study was to confirm the positive rate of DT for AAD in a larger population in an emergency setting and to verify the factors related to the result of DT. We could review the D-dimer values on admission of a large population of AAD patients because it has been routinely measured from January 2001. Methods Study Setting and PatientsThis single-center, retrospective study comprised 113 consecutive patients with AAD who were admitted to the Osaka Mishima Emergency and Critical Care Center within 24 h of symptom onset between January 2001 and July 2005. Patients with cardiac arrest on arrival were excluded. The diagnosis of AAD was confirmed by thoracic and abdominal contrast-enhanced CT. Blood samples were taken in the emergency room immediately after admission. Study ProtocolThis study was approved by the Human Research Committee at the Osaka Mishima Emergency and Critical Care Center. We reviewed the age, time from the onset of the symptoms to admission (TIME) and serum D-dimer values (latex agglutination, Roche Diagnostic, Tokyo, Japan, normal limit ≤0.4 g/ml). The cut-off value for D-dimer was set to the upper limit of the normal range (ie, 0.4 g/ml) to calculate the positive rate of DT. The positive rate of DT and absolute D-dimer values were compared for each of the Background Previous reports indicate that D-dimer testing (DT) for acute aortic dissection (AAD) has a sensitivity of 100%, but each study comprised less than 30 patients. The aim of this study was to evaluate the positive rate and factors related to the results of DT for AAD in a larger population. Methods and Results DT (cutoff; upper normal limit) was performed for 113 consecutive AAD patients within 24 h of symptom onset. In total, 104 (92%) patients exhibited positive DT. The positive rate of DT showed a low tendency in patients aged less than 70 years and for a time interval from symptom onset to admission within 120 min, and there were significant differences between those with and without a thrombosed false lumen (TFL) (86.4% (n=59)

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