Aortic Syndrome Evidence Synthesis: The ASES Study
Background
An acute aortic syndrome occurs when the main blood vessel from the heart (the aorta) develops damage that can lead to life threatening bleeding or blockage. It is diagnosed with a specialised scan called a CT aortogram. Symptoms of acute aortic syndrome include chest pain, back pain, abdominal pain, or fainting. Around two million people attend NHS emergency departments each year with these symptoms, so we need to decide how we select people for scanning.
The Aortic Dissection Detection Risk Score (ADD-RS) uses patient characteristics, symptoms, and examination findings to score the risk of aortic syndrome from low (zero points) to high (three points). Blood tests can detect chemicals that are released during aortic damage – most notably a blood test called D-dimer. We aimed to determine whether the ADD-RS and D-dimer could be used to select patients for scanning.
We searched the scientific literature for any research studies that evaluated the accuracy of clinical scores and blood tests for detecting acute aortic syndrome. We used a statistical technique called meta-analysis to combine results from ten studies of the ADD-RS, six studies of the ADD-RS with D-dimer, and eighteen studies of D-dimer alone. Our analysis showed that nearly all patients with acute aortic syndrome have an ADD-RS score above zero or positive D-dimer test.
We developed a mathematical model to simulate what would happen if the ADD-RS and/or D-dimer were used to select people with possible acute aortic syndrome for scanning. This showed that using the ADD-RS and D-dimer for all patients with symptoms suggesting acute aortic syndrome would result in high rates of CT scanning. However, if clinicians can identify people for testing whose risk of aortic syndrome is greater than zero, then ADD-RS and D-dimer can be cost-effective in selecting people for a scan.
An online presentation hosted by the Aortic Dissection Charitable Trust is available here:
https://aorticdissectioncharitabletrust.org/insights-from-the-ases-study/
Publications
Thokala P, Goodacre S, Cooper G, et al. Decision analytical modelling of strategies for investigating suspected acute aortic syndrome. Emerg Med J 2024
https://emj.bmj.com/content/early/2024/11/01/emermed-2024-214222
Essat M, Goodacre S, Pandor A, Ren Sa, Ren Sh, Clowes M. Diagnostic accuracy of D-dimer for acute aortic syndromes: Systematic review and meta-analysis. Ann Emerg Med 2024.
https://www.sciencedirect.com/science/article/pii/S0196064424002609#bib10
Ren S, Essat M, Pandor A, Goodacre S, Ren S, Clowes M, et al. (2024) Diagnostic accuracy of the aortic dissection detection risk score alone or with D-dimer for acute aortic syndromes: Systematic review and meta-analysis. PLoS ONE 19(6): e0304401.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0304401
Wren J, Goodacre S, Pandor A, Essat M, Clowes M, Cooper G, Hinchliffe R, Reed M, Thomas S, Wilson S. Diagnostic accuracy of alternative biomarkers for acute aortic syndrome: a systematic review. Emerg Med J 2024.
https://emj.bmj.com/content/41/11/678
Goodacre S, Lechene V, Cooper G, Wilson S, Zhong J. Easily missed: Acute aortic syndrome. BMJ. 2024; 386: e080870.
https://www.bmj.com/content/386/bmj-2024-080870
Funder
This project is funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (NIHR136085). Any views or opinions expressed are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health.
The Team
| Name | Organisation | Email address |
|---|---|---|
|
Prof. Steve Goodacre (Chief Investigator) |
The University of Sheffield |
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|
The University of Sheffield |
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| Dr. Praveen Thokala |
The University of Sheffield |
|
| Dr. Shijie Ren |
The University of Sheffield |
|
|
The University of Sheffield |
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|
The University of Sheffield |
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|
The University of Sheffield |
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|
Sheffield Teaching Hospitals NHS Trust |
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| Prof. Robert Hinchliffe |
The University of Bristol |
robert.hinchliffe@bristol.ac.uk |
|
Edinburgh Royal Infirmary |
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| Dr. Steve Thomas |
Sheffield Teaching Hospitals NHS Trust |
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| Dr. Sarah Wilson |
Frimley Health NHS Trust |
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|
Catherine Fowler |
The Aortic Dissection Charitable Trust |
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|
Valerie Lechene |
The Aortic Dissection Charitable Trust |
Links
NIHR ASES web page
https://fundingawards.nihr.ac.uk/award/NIHR151853
The Aortic Dissection Charitable Trust
https://aorticdissectioncharitabletrust.org/
The DAShED study