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

• Verfasst von: Koch, Vitali [VerfasserIn]
• Verfasst von: Booz, Christian [VerfasserIn]
• Verfasst von: Gruenewald, Leon D. [VerfasserIn]
• Verfasst von: Albrecht, Moritz H. [VerfasserIn]
• Verfasst von: Gruber-Rouh, Tatjana [VerfasserIn]
• Verfasst von: Eichler, Katrin [VerfasserIn]
• Verfasst von: Yel, Ibrahim [VerfasserIn]
• Verfasst von: Mahmoudi, Scherwin [VerfasserIn]
• Verfasst von: Scholtz, Jan-Erik [VerfasserIn]
• Verfasst von: Martin, Simon S. [VerfasserIn]
• Verfasst von: Graf, Christiana [VerfasserIn]
• Verfasst von: Vogl, Thomas J. [VerfasserIn]
• Verfasst von: Weber, Christophe [VerfasserIn]
• Verfasst von: Hardt, Stefan [VerfasserIn]
• Verfasst von: Frey, Norbert [VerfasserIn]
• Verfasst von: Giannitsis, Evangelos [VerfasserIn]
• Titel: Diagnostic performance and predictive value of D-dimer testing in patients referred to the emergency department for suspected myocardial infarction
• Verf.angabe: 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
• E-Jahr: 2022
• Jahr: 10 May 2022
• Umfang: 8 S.
• Fussnoten: Gesehen am 14.07.2022
• Titel Quelle: Enthalten in: Clinical biochemistry
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 1967
• Jahr Quelle: 2022
• Band/Heft Quelle: 104(2022), Seite 22-29
• ISSN Quelle: 1873-2933
• DOI: doi:10.1016/j.clinbiochem.2022.02.003
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Acute Coronary Syndrome
• Sach-SW: D-dimer
• Sach-SW: Mortality
• Sach-SW: Myocardial Infarction
• Sach-SW: Unstable Angina
• K10plus-PPN: 1810183855

Abstract

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.