Acute Ischemic Heart DiseaseD -Dimer is an early diagnostic marker of coronary ischemia in patients with chest pain☆,☆☆
Section snippets
Methods
This prospective study enrolled 300 consecutive patients admitted to a teaching hospital ED for acute chest pain from September 15, 1996, to January 18, 1997. All patients were 25 years or older and came to the ED with a chief symptom of central or left-sided chest pain. Only patients with onset of symptoms <6 hours were eligible for study. Informed consent was obtained from all patients, and the study protocol was approved by the local ethics committee.
The physician on duty took the medical
Results
One hundred sixty-two patients (63%) were diagnosed with nonischemic chest pain from the following causes: musculoskeletal pain (n = 79), anxiety (n = 50), pain of gastrointestinal origin (n = 15), tachyarrhythmias (atrial flutter and fibrillation) (n = 10), pericarditis (n = 2), pneumothorax (n = 2), pulmonary embolism (n = l), bronchial asthma (n = l), pneumonia (n = l), and urticaria (n = l).
Fifty-eight patients (23%) had UA, and 37 patients (14%) had MI develop. Twenty-one patients (57%)
Discussion
These results suggest that D -dimer measurement can improve clinical decision models to facilitate risk stratification. We found substantially increased D -dimer levels in patients with MI and UA. Our findings also provide a clinically useful D -dimer threshold in MI (>500 μg/L), which added to the conventional diagnosis in the ED and increased the diagnostic sensitivity for MI from 73% to 92%. TAT, F1+2, and activated factor VII provided no additional diagnostic information for patients with
Acknowledgements
We thank the emergency team for their support. We also thank Ms Rosa Felices for technical assistance and Dr J. Soler for his critical review.
References (29)
- et al.
Failure of new biochemical markers to exclude acute myocardial infarction at admission
Lancet
(1993) - et al.
Emergency room technetium-99m sestamibi imaging to rule out acute myocardial ischemic events in patients with nondiagnostic electrocardiograms
J Am Coll Cardiol
(1993) - et al.
Fibrinogen, factor VII clotting activity and coronary artery disease severity
Atherosclerosis
(1990) Plasma assays for derivatives of fibrin and of fibrinogen, based on monoclonal antibodies
Fibrinolysis
(1988)- et al.
Utility of cross-linked fibrin degradation products in the diagnosis of pulmonary embolism
Am Heart J
(1988) - et al.
Measurement of D -dimer in plasma as diagnostic aid in suspected pulmonary embolism
Lancet
(1991) - et al.
Time significance of acute thrombotic reactant markers in patients with and without silent myocardial ischemia and overt unstable angina pectoris
Am J Cardiol
(1995) - et al.
The pathophysiology of the prethrombotic state in humans: insights gained from studies using markers of hemostatic system activation
Blood
(1987) - et al.
Incremental prognostic value of serum levels of troponin T and C-reactive protein on admission in patients with unstable angina pectoris
Am J Cardiol
(1998) - et al.
Electrocardiographic and clinical criteria for recognition of acute myocardial infarction based on analysis of 3,697 patients
Am J Cardiol
(1983)
Limited value of the resting electrocardiogram in assessing patients with recent onset chest pain: lessons from a chest pain clinic
Br Heart J
Early diagnosis of acute myocardial infarction with reference to the diagnosis of the intermediate coronary syndrome study
Acta Med Scan
A computer protocol to predict myocardial infarction in emergency department patients with chest pain
N Engl J Med
Value of regional wall motion abnormality in the emergency room diagnosis of acute myocardial infarction: a prospective study using two-dimensional echocardiography
Circulation
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Partly supported by a grant from the Comisión Interministerial de Ciencia y Tecnología (CICYT); SAF 96/0058 Spain.
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Reprint requests: Robert S. Schwartz, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905.E-mail: [email protected]