Troponin I and D-Dimer for Discriminating Acute Pulmonary Thromboembolism from Myocardial Infarction.

Abstract

BACKGROUND:

Acute pulmonary thromboembolism (APTE) is a life-threatening condition, often manifesting with chest pain, dyspnea, and increased cardiac biomarkers including cardiac troponin I (CTI) and D-dimer. Therefore, APTE is often misdiagnosed with classical non-ST elevation myocardial infarction (NSTEMI), resulting in unnecessary coronary interventions and a delay of therapy.

OBJECTIVES:

Our aim was to distinguish APTE from NSTEMI based on CTI and D-dimer levels.

METHODS:

Complete clinical and laboratory data sets from APTE patients (n = 123) were compared with matched NSTEMI patients (n = 123) who presented with chest pain. The APTE diagnosis was confirmed by chest tomography, angiography, or radionuclide ventilation-perfusion scan, while NSTEMI was established by clinical symptoms, cardiac biomarkers, and coronary angiography. Clinical characteristics, CTI (initial and peak), and D-dimer levels at presentation were retrospectively analyzed.

RESULTS:

The clinical characteristics were not different between APTE and NSTEMI patients. However, significantly lower initial CTI (0.2 ± 0.5 vs. 4.4 ± 9.5 ng/ml) and peak CTI (0.7 ± 2.7 vs. 17.1 ± 20.4 ng/ml), but higher initial D-dimer (9.8 ± 9.4 vs. 1.6 ± 3.6 ng/ml), distinguished APTE from NSTEMI. By receiver operating characteristic curve analysis, the cutoff values for initial CTI, peak CTI, and D-dimer were 0.25, 0.98, and 3.18 ng/ml, respectively.

CONCLUSION:

Patients with APTE exhibited lower initial and peak CTI but higher D-dimer levels than NSTEMI patients. Assessing cardiac biomarkers is useful for differentiating APTE from NSTEMI. Further large randomized biomarker studies are urgently needed to facilitate a better APTE diagnosis since clinical characteristics are not particularly helpful.

• Authors: Soo Jin Kim, Moo Hyun Kim, Kwang Min Lee, Tae Hyung Kim, Sun Yong Choi, Min Kook Son, Ji Woen Park, Victor L Serebruany
• Journal: Cardiology (Cardiology) 2017 Vol. 136 Issue 4 Pg. 222-227 ISSN: 1421-9751 [Electronic] Switzerland
• PMID: 27816974 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2016 S. Karger AG, Basel.

Chemical References

• Biomarkers
• Fibrin Fibrinogen Degradation Products
• Troponin I
• fibrin fragment D

Topics

• Acute Disease
• Aged
• Biomarkers (blood)
• Chest Pain (etiology)
• Coronary Angiography
• Electrocardiography
• Female
• Fibrin Fibrinogen Degradation Products (analysis)
• Humans
• Male
• Middle Aged
• Non-ST Elevated Myocardial Infarction (blood, diagnostic imaging)
• Pulmonary Embolism (blood, diagnostic imaging)
• ROC Curve
• Republic of Korea
• Retrospective Studies
• Troponin I (blood)