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KMID : 0385920090200040365
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Journal of the Korean Society of Emergency Medicine
2009 Volume.20 No. 4 p.365 ~ p.371
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Usefulness of D-dimer Test as Early Marker for Predicting Myocardial Infarction in Patients with Acute Coronary Syndrome and non-ST Elevation ECG
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Hur Sun-Beom
Park Sang-O
Lee Kyeong-Ryong
Baek Kwang-Je
Hong Dae-Young
Kim Eun-Jung
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Abstract
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Purpose: To determine if D-dimer level is a supportive marker in the prediction of myocardial infarction in patients with acute coronary syndrome and non-ST elevation ECG, who arrive in the emergency room.
Methods: We conducted a prospective, observational study of patients with acute chest pain that had occurred within 24 hours and who had non-ST elevation on ECG. They were managed according to the 2005 ACLS guidelines; the following clinical tests were performed: D-dimer, cardiac markers, and CAG. Final diagnoses were divided into 3 groups: myocardial infarction (MI), unstable angina (UA), and others (non-specific or angina).
Results: Ninety-three (93) patients were included in this study. The mean D-dimer value was higher in patients diagnosed with MI (1.04±2.12 ug/dl) than in those patients diagnosed with UA (0.48±0.51 ug/dl) (p=0.026). At the 0.38 ug/dl diagnotic threshold estimated by ROC curve analysis, corresponding to the cutoff for diagnosis of myocardial infarction then in this value sensitivity and specificity of D-dimer were 70.6% and 62.7%. In cardiac enzymes, sensitivity and specificity of Tn-I were 47.1% and 98.3, respectively, and for CK-MB were 35.3% and 98.3%, respectively.
Conclusion: D-dimer value may be at higher levels in AMI and the sensitivity of D-dimer was higher than that of TnI and CK-MB in patients with acute coronary syndrome and non-ST elevation ECG. However, because of relatively lower sensitivity and specificity of the D-dimer test, this test may useful as supporting marker for predicting myocardial infarction.
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KEYWORD
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D-dimer, Unstable angina, Myocardial infarction
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