The Prediction Value Of WELLS Score Combined With D-dimer In The Diagnosis Of Acute Pulmonary Embolism And Aortic Dissection

Background: Aortic dissection(AD) and pulmonary embolism(PE) is common in patients with chest pain of cardiovascular emergencies.because of the acute onset, high mortality, clinical manifestations of atypical, it is difficult to identify and easy to misdiagnosis.Part of high-risk patients with acute chest pain who is difficult to diagnose sometimes need to do the primary and pulmonary artery angiography examines.But the primary and pulmonary artery angiography diagnosed lower rate,sometimes may not be clear breach of aortic dissection location.Sometimes it is not easy to clear the sites for some patients with pulmonary embolism.In recent years, more and more studies have shown the wells score, D-dimer have the predictive diagnosis of pulmonary embolism in patients with significant meaning.However, few clinical studies related to the identification and initial screening of aortic dissection and pulmonary embolism.Objective: Discuss Wells score combined with the predictive value of D-dimer in patients with acute chest pain.Methods: A retrospective analysis of general information,D- dimer, wells score of the hospitalized patients who did the primary and pulmonary artery angiography examines in the Bethune First Hospital of Jilin University from December 2013 to December 2015.Results: With all patients doing the primary and pulmonary artery angiography examines,56 patients were diagnosed with pulmonary embolism, 25%;72 patients diagnosed with aortic dissection, 33%;92 patients had no abnormality,42%.Wells score, D-D and combination of the two predict pulmonary embolism, the area under the curve were 0.859(95% CI: 0.803-0.915), 0.783(95% CI: 0.723-0.843), 0.924(95% CI: 0.885-0.963).When combined with the prediction of pulmonary embolism area under the curve increased significantly.Optimal cut-off point of wells score and D--dimer predicting pulmonary embolism was the Wells score 2 points, aortic dissection 1650.00 ug / L, Youden index was 0.727, sensitivity was 94.6%, specificity 78.0%.When D--dimer elevated and below 1650 ug / L, the proportion of patients ≤1 wells ratings points in aortic dissection group was significantly higher than the control group and pulmonary embolism group.Conclusion: 1. For patients with atypical chest pain with suspected aortic dissection or pulmonary embolism, the primary and pulmonary artery has a clear clinical diagnostic value, but there are some limitations. 2.D-dimer and wells score exclude large negative value, but the positive predictive value remains to be judged. 3.wells score combined with D-dimer had a clear clinical predictors meaning of aortic dissection and pulmonary embolism:when wells score ≥2 points, D- dimer ≥1650ug / L, the more inclined pulmonary embolism may be clinically; when wells score ≤1 points, D- dimer increased(≥500ug / L) and <1650ug / L, aortic dissection may prefer the clinical。...