Determinants of ELISA D-dimer sensitivity for unstable angina pectoris as defined by coronary catheterization.
Unstable angina pectoris is associated with elevated D-dimer levels. However, the operating characteristics (sensitivity, specificity, positive and negative predictive value) of the D-dimer assay for the diagnosis of coronary artery disease (CAD) are unknown. Using a prospective, observational design, we collected blood from 54 patients with unstable angina pectoris at admission and assayed for ELISA D-dimer levels. The sensitivity, specificity, and negative and positive prediction values for angiographically determined coronary artery disease were calculated at multiple discriminate levels. All patients underwent coronary catheterization. A statistically significant correlation was noted between ELISA D-dimer levels and age, male sex, hypertension, use of beta-blocker, fibrinogen levels and catheterization findings. No correlation was noted between ELISA D-dimer levels and degree of the coronary artery disease. Best results were provided at a discriminate level of 270 ng/ml, with sensitivity 70%, negative predictive value 72%, and overall accuracy 67%. All discriminate levels, however, provided values too low for diagnosis. In conclusion, ELISA D-dimer assay is a non-sensitive, non-specific test for coronary artery disease as defined by coronary catheterization. However, the assay adds information regarding the severity of disease in patients presenting with acute coronary syndrome.
Shitrit
David
D
Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel. davariel@zahav.net.il
Bar-Gil Shitrit
Ariella
A
Rudensky
Bernard
B
Sulkes
Jaqueline
J
Tzviony
Dan
D
D000789:Angina, Unstable / Q000097:blood / Q000139:chemically induced* / Q000000981:diagnostic imaging; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D