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KMID : 0385920140250060756
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Journal of the Korean Society of Emergency Medicine
2014 Volume.25 No. 6 p.756 ~ p.763
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Usefulness of D-dimer as a Predictor of High-risk Patients for Early Invasive Treatment and Early Death in Non-ST Elevation Acute Coronary Syndrome Patients
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Choi Sung-Mo
Na June-Ho
Lee Ki-Ho
Lee Kyeong-Ryong
Hong Dae-Young
Baek Kwang-Je
Park Sang-Min
Park Sang-O
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Abstract
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Purpose: The aim of the study is to evaluate the efficacy ofinitial plasma D-dimer levels measured in the emergencydepartment (ED) in prediction of early 28-day mortality andhigh-risk patients for early invasive treatment in patients withNon-ST elevation acute coronary syndrome (NST-ACS).
Methods: This is a retrospective clinical study of NST-ACSpatients in the ED. All patients were managed according tothe 2010 ACLS guidelines. EKG, cardiac markers, and Ddimerwere analyzed. All data were collected via electronicmedical records. The two major endpoints were 28-daymortality and high-risk patients who were defined as caseswith one of the following: refractory ischemic chest discomfort,recurrent/persistent ST deviation, ventricular tachycardia,hemodynamic instability, and signs of heart failure. Weassessed the relationship between initial D-dimer levels,and high-risk patients, and 28-day mortality.
Results: A total of 390 patients were analyzed. There were25 high-risk patients (6.41%) and 10 non-survival cases(2.56%). The median (inter-quartile ranges) D-dimer valuewas higher in high-risk patients than in non-high riskpatients (1.36 [0.57 to 2.30] vs. 0.31 [0.23 to 0.53] ug/dL;p<0.0001). Area under curve (AUC) in Receiver-operatorycharacteristic (ROC) curve for D-dimer in high-risk patientswas 0.834 (95% confidence interval: 0.750-0.920) with theoptimum cutoff value of 0.475ug/dL with a sensitivity of 84%and a specificity of 71%. The median value of D-dimer innon-survival cases was higher than in survival cases (1.17[0.84 to 18.46] vs. 0.33 [0.23 to 0.56] ug/dL; p<0.0001). AUC for D-dimer in predicting 28-day mortality was 0.837(95% CI: 0.710-0.964) with the optimum cutoff value of 0.98ug/dL with a sensitivity of 80.0% and a specificity of 86.3%.
Conclusion: The D-dimer level in the initial state might behelpful in predicting high-risk patients for early invasive treatmentor 28-day mortality in patients with NST-ACS in the ED.
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KEYWORD
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D-dimer, Acute coronary syndrome, Percutaneous coronary intervention
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