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

Shy Shin Chang, Si Huei Lee, Jiunn Yih Wu, Hsiao Chen Ning, Te Fa Chiu, Feng Lin Wang, Jung Hsiang Chen, Chih Huang Li, Chien Chang Lee, Rai Chi Chan

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)472-478
Number of pages7
JournalJournal of Thrombosis and Thrombolysis
Volume30
Issue number4
DOIs
Publication statusPublished - Nov 1 2010
Externally publishedYes

Fingerprint

Troponin I
Myocardial Infarction
ROC Curve
fibrin fragment D
Triage
Chronic Renal Insufficiency
Comorbidity
Diabetes Mellitus
Cohort Studies
Multivariate Analysis
Prospective Studies

Keywords

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

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine

Cite this

Evaluation of the value of rapid D-dimer test in conjunction with cardiac troponin I test for early risk stratification of myocardial infarction. / Chang, Shy Shin; Lee, Si Huei; Wu, Jiunn Yih; Ning, Hsiao Chen; Chiu, Te Fa; Wang, Feng Lin; Chen, Jung Hsiang; Li, Chih Huang; Lee, Chien Chang; Chan, Rai Chi.

In: Journal of Thrombosis and Thrombolysis, Vol. 30, No. 4, 01.11.2010, p. 472-478.

Research output: Contribution to journalArticle

Chang, Shy Shin ; Lee, Si Huei ; Wu, Jiunn Yih ; Ning, Hsiao Chen ; Chiu, Te Fa ; Wang, Feng Lin ; Chen, Jung Hsiang ; Li, Chih Huang ; Lee, Chien Chang ; Chan, Rai Chi. / Evaluation of the value of rapid D-dimer test in conjunction with cardiac troponin I test for early risk stratification of myocardial infarction. In: Journal of Thrombosis and Thrombolysis. 2010 ; Vol. 30, No. 4. pp. 472-478.
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AU - Chiu, Te Fa

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AU - Lee, Chien Chang

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