Role of ELISA D‐dimer test in patients with unstable angina pectoris presenting at the emergency department with a normal electrocardiogram

Abstract

Patients with unstable angina pectoris and acute myocardial infarction have higher than normal D-dimer levels. The aim of the study was to determine the value of the D-dimer test in patients with unstable angina pectoris and a normal electrocardiogram on presentation at the emergency department. The study sample included 81 patients who met these criteria. Blood samples collected at admission were subjected to ELISA D-dimer. Findings were correlated with coronary risk factors, use of cardiac medications, blood levels of acute phase reactants (fibrinogen and C-reactive protein), cardiac enzymes levels, length of hospital stay, and catheterization findings. ELISA D-dimer levels were statistically significantly correlated with cardiac risk factors, namely male sex, older age, smoking, and hypertension (r = 0.25, P = 0.02; r = 0.43, P = 0.0001; r = 0.26, P = 0.03; r = 0.35, P = 0.002, respectively), in addition to use of cardiac medications (beta blockers, aspirin, nitrates), levels of acute phase reactants, length of stay, and catheterization findings. On multivariate analysis, only D-dimer level, age, and sex were predictors of length of stay (P = 0.018). The study suggests that D-dimer levels at admission to the emergency department may serve as an additional tool to predict the magnitude of unstable angina pectoris in patients with a normal electrocardiogram. Am.

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

“…We demonstrated that combined use of a lower threshold value of D-dimer test (200 ng/ml) and cTnI test could raise the sensitivity to 98.4% and help triage an additional 20% of low risk patients with typical chest pain and non-diagnostic cTnI and ECG tests. In contrast to previous findings, we did not find D-dimer a highly specific test capable of differentiating patients with MI from other patients with nonspecific chest pain in the early stage [14][15][16][17][18]. Our results echo the conclusion of some recent works, which also did not find added clinically meaningful information to the traditional cardiac necrosis markers [20][21][22].…”

“…Previous studies have demonstrated that the elevation of several molecular markers of thrombin generation are associated with MI and proved to increase the diagnostic sensitivity for MI [14][15][16][17][18]. However, little is known of their potential role in the triage and risk stratification of patients with chest pain in the ED.…”

Long Period and High Level of D-Dimer after Coronary Artery Bypass Grafting Surgery

“…As the specific degradation product of fibrin, Ddimer is the major marker of thrombosis and thrombolysis. [13][14][15][16] Elevated concentration of D-dimer in peripheral blood indicates hyper-coagulation or formation of fresh thrombosis and increased fibrinolysis. 17) These symptoms are also likely related to the formation and coagulation of fibrin in blood vessels and unstable atherosclerotic plaque activities.…”

Biomarkers of Atherosclerosis and Acute Coronary Syndromes - A Clinical Perspective

“…Further, patients in whom the first presentation of coronary heart disease is with AMI may have higher D-dimer levels than patients who first present with stable angina (186). A weak but statistically significant correlation has been demonstrated between plasma D-dimer levels and severity of coronary disease on angiography in patients with unstable angina (187,188). In a cohort of 54 patients who were diagnosed with unstable angina and underwent coronary angiography, D-dimer levels (cutoff 270ng/ml) predicted significant coronary disease on angiography with sensitivity 70%, specificity 50%, PPV 86%, NPV 72%.…”