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

Choi,  Sung Mo; Na,  June Ho; Lee,  Ki Ho; Lee,  Kyeong Ryong; Hong,  Dae Young; Baek,  Kwang Je; Park,  Sang Min; Park,  Sang O

J Korean Soc Emerg Med > Volume 25(6); 2014 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2014;25(6): 756-763.

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

Sung Mo Choi, June Ho Na, Ki Ho Lee, Kyeong Ryong Lee, Dae Young Hong, Kwang Je Baek, Sang Min Park, Sang O Park

¹Department of Emergency Medicine, School of Medicine, Konkuk University Konkuk University Hospital, Seoul, Republic of Korea. empso@kuh.ac.kr
²Department of Emergency Medicine, International St. Mary's Hospital, Incheon, Republic of Korea.
³Department of Emergency Medicine, Konkuk University Chung-Ju Hospital, Chung-Ju, Republic of Korea.

ABSTRACT

PURPOSE:
The aim of the study is to evaluate the efficacy of initial plasma D-dimer levels measured in the emergency department (ED) in prediction of early 28-day mortality and high-risk patients for early invasive treatment in patients with Non-ST elevation acute coronary syndrome (NST-ACS).
METHODS:
This is a retrospective clinical study of NST-ACS patients in the ED. All patients were managed according to the 2010 ACLS guidelines. EKG, cardiac markers, and D-dimer were analyzed. All data were collected via electronic medical records. The two major endpoints were 28-day mortality and high-risk patients who were defined as cases with one of the following: refractory ischemic chest discomfort, recurrent/persistent ST deviation, ventricular tachycardia, hemodynamic instability, and signs of heart failure. We assessed the relationship between initial D-dimer levels, and high-risk patients, and 28-day mortality.
RESULTS:
A total of 390 patients were analyzed. There were 25 high-risk patients (6.41%) and 10 non-survival cases (2.56%). The median (inter-quartile ranges) D-dimer value was higher in high-risk patients than in non-high risk patients (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-operatory characteristic (ROC) curve for D-dimer in high-risk patients was 0.834 (95% confidence interval: 0.750-0.920) with the optimum cutoff value of 0.475ug/dL with a sensitivity of 84% and a specificity of 71%. The median value of D-dimer in non-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 0.98 ug/dL with a sensitivity of 80.0% and a specificity of 86.3%.
CONCLUSION:
The D-dimer level in the initial state might be helpful in predicting high-risk patients for early invasive treatment or 28-day mortality in patients with NST-ACS in the ED.

Key words: D-dimer, Acute coronary syndrome, Percutaneous coronary intervention