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Diagnostic performance and predictive value of D-dimer testing in patients referred to the emergency department for suspected myocardial infarction

Purpose - The study sought to assess the performance of D-dimer testing for the diagnosis of acute coronary syndrome (ACS) and prediction of outcomes in patients admitted for suspected myocardial infarction (MI). - Results - A total of 3,557 patients with suspected ACS presenting to a single center...

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Main Authors: Koch, Vitali (Author) , Booz, Christian (Author) , Gruenewald, Leon D. (Author) , Albrecht, Moritz H. (Author) , Gruber-Rouh, Tatjana (Author) , Eichler, Katrin (Author) , Yel, Ibrahim (Author) , Mahmoudi, Scherwin (Author) , Scholtz, Jan-Erik (Author) , Martin, Simon S. (Author) , Graf, Christiana (Author) , Vogl, Thomas J. (Author) , Weber, Christophe (Author) , Hardt, Stefan (Author) , Frey, Norbert (Author) , Giannitsis, Evangelos (Author)
Format: Article (Journal)
Language:English
Published: 10 May 2022
In: Clinical biochemistry
Year: 2022, Volume: 104, Pages: 22-29
ISSN:1873-2933
DOI:10.1016/j.clinbiochem.2022.02.003
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.clinbiochem.2022.02.003
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0009912022000510
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Author Notes:Vitali Koch, Christian Booz, Leon D. Gruenewald, Moritz H. Albrecht, Tatjana Gruber-Rouh, Katrin Eichler, Ibrahim Yel, Scherwin Mahmoudi, Jan-Erik Scholtz, Simon S. Martin, Christiana Graf, Thomas J. Vogl, Christophe Weber, Stefan E. Hardt, Norbert Frey, Evangelos Giannitsis
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Summary:Purpose - The study sought to assess the performance of D-dimer testing for the diagnosis of acute coronary syndrome (ACS) and prediction of outcomes in patients admitted for suspected myocardial infarction (MI). - Results - A total of 3,557 patients with suspected ACS presenting to a single center with a broad range of symptoms including atypical chest pain were retrospectively recruited between 02/2012-01/2019. Of the study cohort, 435 patients had unstable angina (UA), 420 non-ST-segment elevation myocardial infarction (NSTEMI), 22 ST-segment elevation myocardial infarction (STEMI), and 2,680 non-coronary chest pain. Plasma D-dimer concentrations in patients with hs-cTnT > 14 ng/L differed significantly from those with hs-cTnT < 14 ng/L (1.5 ± 3.6 mg/L vs. 0.5 ± 0.8 mg/L; p < 0.0001). Positive predictive value for a final diagnosis of ACS increased proportionally to rising D-dimer concentrations. The area under the curve (AUC) to discriminate STEMI from non-coronary chest pain (AUC 0.729, 95% confidence interval [CI] 0.71-0.75) was moderate and differed not significantly to UA (AUC 0.595, 95% CI 0.58-0.61; p = 0.0653). During a median follow-up of 29 months, higher D-dimer was associated with a significantly increased risk of recurrent MI (quartile 4 vs. 1: hazard ratio [HR], 6.9 [95% CI 1.2-39.9]; p < 0.0001) and higher all-cause mortality (HR, 17.4 [95% CI 4.3-69.9]; p < 0.0001). D-dimer was an independent predictor of all-cause mortality (p < 0.0001) and subsequent MI events (p = 0.0333). - Conclusions - D-dimer testing revealed great potential to provide independent prognostic information on recurrent MI and all-cause mortality. However, D-dimers do not improve the diagnostic performance except if values exceed the 95th percentile.
Item Description:Gesehen am 14.07.2022
Physical Description:Online Resource
ISSN:1873-2933
DOI:10.1016/j.clinbiochem.2022.02.003

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