D-dimer/troponin ratio in the differential diagnosis of acute pulmonary embolism from non-ST elevation myocardial infarction.

Abstract

BACKGROUND/AIMS:

The aim of this study was to investigate useful cardiac biomarkers in the differential diagnosis of acute pulmonary embolism (APE) with troponin elevation from acute non-ST elevation myocardial infarction (NSTEMI).

METHODS:

A total of 771 consecutive NSTEMI patients with D-dimer measurements and 90 patients with troponin-I (TnI) elevation out of 233 APE patients were enrolled, and cardiac biomarkers were compared.

RESULTS:

D-dimer elevation was noted in 382 patients with NSTEMI (49.5%), and TnI elevation was noted 90 out of 233 APE patients (38.6%). Unnecessary coronary angiography was performed in 10 patients (11.1%) among 90 APE patients with TnI elevation. D-dimer was significantly elevated in APE than in NSTEMI (9.9 ± 11.6 mg/L vs. 1.8 ± 4.3 mg/L, p < 0.001), whereas TnI was significantly elevated in NSTEMI (22.4 ± 41.5 ng/mL vs. 0.7 ± 1.4 ng/mL, p < 0.001). D-dimer/TnI ratio was significantly higher in APE than in NSTEMI (50.6 ± 85.3 vs. 1.6 ± 5.7, p < 0.001). On receiver operation characteristic curve analysis, the optimal cut-off value for differentiating APE from NSTEMI was 1.12 mg/L for D-dimer (sensitivity 81.1%, specificity 70.2%), 0.72 ng/mL for TnI (sensitivity 80.6%, specificity 78.9%), and 1.82 for D-dimer/TnI ratio (sensitivity 93.3%, specificity 86.6%).

CONCLUSION:

D-dimer/TnI ratio would be a simple and useful parameter for differentiating APE with cardiac troponin elevation from NSTEMI. Optimal cardiovascular imaging to identify APE should be considered in patients with D-dimer/ TnI ratio > 1.82 before performing coronary angiography to avoid unnecessary invasive procedure.

• Authors: Jong Yoon Kim, Kye Hun Kim, Jae Yeong Cho, Doo Sun Sim, Hyun Ju Yoon, Nam Sik Yoon, Young Joon Hong, Hyung Wook Park, Ju Han Kim, Youngkeun Ahn, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park
• Journal: The Korean journal of internal medicine (Korean J Intern Med) Vol. 34 Issue 6 Pg. 1263-1271 (Nov 2019) ISSN: 2005-6648 [Electronic] Korea (South)
• PMID: 30685960 (Publication Type: Comparative Study, Journal Article, Observational Study)

Chemical References

• Biomarkers
• Fibrin Fibrinogen Degradation Products
• Troponin I
• fibrin fragment D

Topics

• Acute Disease
• Aged
• Aged, 80 and over
• Biomarkers (blood)
• Diagnosis, Differential
• Female
• Fibrin Fibrinogen Degradation Products (analysis)
• Humans
• Male
• Middle Aged
• Non-ST Elevated Myocardial Infarction (blood, diagnosis)
• Predictive Value of Tests
• Pulmonary Embolism (blood, diagnosis)
• Reproducibility of Results
• Retrospective Studies
• Troponin I (blood)