title: The role of enzyme-linked immunosorbent assay D-dimer in patients with acute coronary syndrome presenting with normal cardiac enzymes.
abstract: Plasma D-dimer levels, the primary degradation product of cross-linked fibrin, are elevated in acute coronary syndrome (ACS). However, the role of D-dimer in patients presenting to the Emergency Department with ACS and normal cardiac enzymes is unknown. We conducted a prospective, observational study in the Emergency Department of a major tertiary university-affiliated center. The study included 124 patients presented to the Emergency Department with ACS and normal cardiac enzymes. Blood samples were collected and assayed for D-dimer levels with the enzyme-linked immunosorbent assay (ELISA) test. The D-dimer values were correlated with the clinical, laboratory and electrocardiographic findings on admission, as well as with the catheterization findings and with hospital length of stay. ELISA D-dimer levels positively correlated with sex, hypertension and smoking (r = -0.27, P = 0.002; r = 0.33, P = 0.0002; and r = -0.24, P = 0.007, respectively). Significant correlation was also observed between ELISA D-dimer and cardiac medications including beta-blocker (r = 0.22, P = 0.01), aspirin (r = 0.18, P = 0.04), nitrate (r = 0.20, P = 0.002), acute phase reactants fibrinogen (r = 0.45, P = 0.0001) and C-reactive protein (r = 0.29, P = 0.004), ischemic electrocardiographic changes (r = 0.21, P = 0.02) and length of stay (r = 0.29, P = 0.001). The catheterization findings were also correlated with the ELISA D-dimer levels (r = 0.31, P = 0.02). The ELISA D-dimer test may add important clinical data concerning patients with ACS and normal cardiac enzymes.
authors.affiliation: Internal Medicine Department, Shaare-Zedek Medical Center, Jerusalem, Israel.
authors.forename: Ariella Bar-Gil
authors.initials: AB
authors.lastname: Shitrit
authors.forename: Dan
authors.initials: D
authors.lastname: Tzivony
authors.forename: Yuval
authors.initials: Y
authors.lastname: Shilon
authors.forename: Bernard
authors.initials: B
authors.lastname: Rudensky
authors.forename: Jacklin
authors.initials: J
authors.lastname: Sulkes
authors.forename: Natan
authors.initials: N
authors.lastname: Gutterer
authors.forename: David
authors.initials: D
authors.lastname: Shitrit
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D004562:Electrocardiography; D004632:Emergency Medical Services; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D004798:Enzymes / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D007511:Ischemia / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000201:enzymology; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D004798:Enzymes; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D