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Evaluation of the value of rapid D-dimer test in conjunction with cardiac troponin I test for early risk stratification of myocardial infarction

Journal of Thrombosis and Thrombolysis volume 30, pages 472–478 (2010)Cite this article

Abstract

We sought to determine the diagnostic value of a D-dimer test for myocardial infarction (MI). The prospective cohort study was carried in the ED of a university hospital. All included patients were tested for D-dimer and cardiac troponin I (cTnI) on ED admission and additional cTnI 6 h later. AMI was retrospectively confirmed by employing the ESC–ACC–AHA–WHF 2007 universal definition. The discriminative value of D-dimer test was assessed by ROC curve analysis. Multivariate analysis was used to identify independent risk factors associated with D-dimer elevation other than MI. A total of 178 patients were included in this study. Median D-dimer levels were significantly higher in MI patients. A D-dimer value greater than 200 ng/ml was significantly associated with MI. When used alone, the test has a high sensitivity of 91.8% but a low specificity of 23.9%. Combined use of cTnI and D-dimer tests raised the sensitivity to 98.4% and helped early triage a subgroup of low risk patients. However, the test had the downside of 58% false positives. High false positives could be partly explained by the high prevalence of underlying hypercoagulable comorbidities. Diabetes mellitus with chronic renal insufficiency was identified as the strongest risk factor associated with D-dimer elevation in patients without MI. D-dimer test alone has a low diagnostic value for MI. Co-existing hypercoagulable conditions may confound the results. Combining cTnI and D-dimer tests enables early identification a low risk group of patients for MI at the cost of high false positives.

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Affiliations

  1. Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan

    Shy-Shin Chang, Jiunn-Yih Wu, Te-Fa Chiu, Feng-Lin Wang, Jung Hsiang Chen & Chih-Huang Li

  2. Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Shy-Shin Chang

  3. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Shy-Shin Chang

  4. Department of Rehabilitation and Physical Medicine, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan

    Si-Huei Lee & Rai-Chi Chan

  5. Department of Clinical Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Hsiao-Chen Ning

  6. Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Chien-Chang Lee

  7. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Chien-Chang Lee

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  1. Shy-Shin Chang
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  2. Si-Huei Lee
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  6. Feng-Lin Wang
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  7. Jung Hsiang Chen
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  8. Chih-Huang Li
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  9. Chien-Chang Lee
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Correspondence to Chien-Chang Lee or Rai-Chi Chan.

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S.-S. Chang and S.-H. Lee contributed equally to this work.

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Chang, SS., Lee, SH., Wu, JY. et al. Evaluation of the value of rapid D-dimer test in conjunction with cardiac troponin I test for early risk stratification of myocardial infarction. J Thromb Thrombolysis 30, 472–478 (2010). https://doi.org/10.1007/s11239-010-0469-1

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  • DOI: https://doi.org/10.1007/s11239-010-0469-1

Keywords

  • D-dimer
  • Myocardial infarction
  • Diabetes mellitus
  • Chronic renal insufficiency