Prognostic Value of D‐Dimer in Acute Type A Aortic Dissection and Intramural Hematoma: Observations from the Acute Aortic Syndrome Group of the Registry of Acute Non‐Traumatic Chest Pain in China

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.