Back to all available

Development and validation of a predictive model for differentiating Acute Aortic Dissection from Myocardial Infarction

cardiology
emergency-and-critical-care
internal-medicine
surgery-and-surgical-specialties
healthcare-services

Abstract

Background: Acute aortic dissection (AAD) and acute myocardial infarction (AMI) typically present with acute chest pain, posing significant challenges for their clinical differentiation. Misdiagnosis can lead to severe and fatal outcomes. Although coronary and aortic angiography are the gold standards for diagnosis, their routine application in emergency triage is impractical and associated with significant risk. Therefore, this study aimed to develop a noninvasive, rapid diagnostic model to circumvent the limitations of gold-standard methods in early differentiation, thereby providing a safe and effective tool for emergency decision-making.

Methods: We retrospectively collected laboratory data from patients diagnosed with AAD or acute myocardial infarction (AMI). A diagnostic model was developed using univariate and multivariate logistic regression analyses, followed by a comprehensive evaluation and validation.

Results: Glomerular filtration rate (GFR), lymphocyte count (LYM), creatinine (Crea), and AST/ALT ratio were identified as independent predictors for distinguishing AAD from acute myocardial infarction (AMI). A nomogram incorporating these four indicators demonstrated excellent discriminative ability, with an area under the curve (AUC) of 0.859 (95% CI: 0.818–0.899) in the training set and 0.854 (95% CI: 0.790–0.917) in the validation set.

Conclusion: The four-variable nomogram model based on GFR, LYM, Crea, and AST/ALT ratio proved to be a robust and validated tool, offering a reliable, noninvasive method for the differential diagnosis of AAD and AMI in emergency settings.

Ask to review this manuscript

Notes for potential reviewers

  • Volunteering is not a guarantee that you will be asked to review. There are many reasons: reviewers must be qualified, there should be no conflicts of interest, a minimum of two reviewers have already accepted an invitation, etc.
  • This is NOT OPEN peer review. The review is single-blind, and all recommendations are sent privately to the Academic Editor handling the manuscript. All reviews are published and reviewers can choose to sign their reviews.
  • What happens after volunteering? It may be a few days before you receive an invitation to review with further instructions. You will need to accept the invitation to then become an official referee for the manuscript. If you do not receive an invitation it is for one of many possible reasons as noted above.
  • PeerJ does not judge submissions based on subjective measures such as novelty, impact or degree of advance. Effectively, reviewers are asked to comment on whether or not the submission is scientifically and technically sound and therefore deserves to join the scientific literature. Our Peer Review criteria can be found on the "Editorial Criteria" page - reviewers are specifically asked to comment on 3 broad areas: "Basic Reporting", "Experimental Design" and "Validity of the Findings".
  • Reviewers are expected to comment in a timely, professional, and constructive manner.
  • Until the article is published, reviewers must regard all information relating to the submission as strictly confidential.
  • When submitting a review, reviewers are given the option to "sign" their review (i.e. to associate their name with their comments). Otherwise, all review comments remain anonymous.
  • All reviews of published articles are published. This includes manuscript files, peer review comments, author rebuttals and revised materials.
  • Each time a decision is made by the Academic Editor, each reviewer will receive a copy of the Decision Letter (which will include the comments of all reviewers).

If you have any questions about submitting your review, please email us at [email protected].