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


OBJECTIVE
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.


CONCLUSIONS
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.
Department of Cardiology, Dong-A University Hospital, Busan, South Korea.
Soo Jin
SJ
Kim
Moo Hyun
MH
Kim
Kwang Min
KM
Lee
Tae Hyung
TH
Kim
Sun Yong
SY
Choi
Min Kook
MK
Son
Ji Woen
JW
Park
Victor L
VL
Serebruany
D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000097:blood* / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000097:blood* / Q000000981:diagnostic imaging; D012372:ROC Curve; D056910:Republic of Korea; D012189:Retrospective Studies; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D019210:Troponin I; C036309:fibrin fragment D