Utility of rapid D-dimer measurement for screening of acute cardiovascular disease in the emergency setting

Tokita, Yukichi; Kusama, Yoshiki; Kodani, Eitaro; Tadera, Takeshi; Nakagomi, Akihiro; Atarashi, Hirotsugu; Mizuno, Kyoichi

doi:10.1016/j.jjcc.2008.12.001

Cited by 17 publications

(14 citation statements)

References 22 publications

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“…A recent study demonstrated that D-dimer using the cut-off value of 500 ng/ml showed a high sensitivity of 96.6% and a high negative predictive value of 97.6% [15]. However, D-dimer is also elevated in many diseases, such as pulmonary embolism [16,17], ACS [17][18][19], and stroke [20], which can and do mimic clinical presentation of AAD. If patients present to the ER with elevated D-dimer level and without typical clinical presentation of AAD, physicians may not perform diagnostic imaging studies.…”

Section: Discussionmentioning

confidence: 99%

Factors leading to failure to diagnose acute aortic dissection in the emergency room

Kurabayashi

Miwa

Ueshima

et al. 2011

Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Factors leading to failure to diagnose acute aortic dissection in the emergency room

Kurabayashi

Miwa

Ueshima

et al. 2011

Journal of Cardiology

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“…21 Moreover, Tokita et al found that D-dimer showed significantly higher positive test rate for the detection of ACS in the very early phase compared with troponin T and therefore they concluded that the D-dimer was regarded useful for the screening of ACS in the emergency setting. 22 In contrast, Itakura et al reported that D-dimer did not distinguish patients presenting with AMI from those with stable angina. 19 Another 2 large prospective studies suggested that D-dimer did not aid detection of ACS or predict prognosis above and beyond established risk factors.…”

Section: Value Of D-dimer As a Predictor Of Severity In Cadmentioning

confidence: 95%

Plasma d-Dimer as a Useful Marker Predicts Severity of Atherosclerotic Lesion and Short-Term Outcome in Patients With Coronary Artery Disease

Gong

Yang

Sha

et al. 2016

Clin Appl Thromb Hemost

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Increased d-dimer is indicative of a hypercoagulable state and found to be associated with acute coronary syndromes. The present study aimed to evaluate whether plasma d-dimer levels could predict subsequent major clinical events in patients with coronary artery disease (CAD). First, 2209 angiographic-proven patients with CAD were consecutively enrolled. Then, all patients were subjected to follow up for an average of 18 months (ranged from 14 to 1037 days). The relationships of the plasma d-dimer with the severity of CAD and future clinical outcomes were evaluated. We found that plasma d-dimer was higher in patients with prior myocardial infarction (MI) than that in patients with nonprior MI (P = .006). Multivariate linear regression analysis suggested that the plasma d-dimer was linked to the severity of CAD assessed by Gensini score (β = 0.052, 95% confidence interval [CI]: 1.20-6.84, P = .005) even after adjusting for confounding factors. During the follow-up, 42 patients underwent prespecified outcomes. After adjustment for multiple variables in the Cox regression model, the d-dimer levels remained to be a potential predictor of total outcome (hazard ratio = 1.22, 95% CI: 1.09-1.37, P = .001). Therefore, plasma d-dimer levels appeared to be a useful predictor for the severity of CAD and the subsequent major clinical events.

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“…In 257 patients with chest pain, raised D-dimer had an independent diagnostic value for AMI (positive and negative predictive values estimated as 92% and 41%, respectively) and increased the diagnostic sensitivity of the electrocardiogram and history from 73% to 92% (47). In another study of 279 patients with suspected ACS, D-dimer showed significantly higher positive test rate for the detection of ACS in the very early phase compared with troponin T and therefore was regarded useful for the screening of ACS in the emergency setting (48). In the ADVANCE Study, however, D-dimer did not distinguish patients presenting with AMI from those with stable angina (38).…”

Section: D-dimermentioning

confidence: 96%

Prognostic Value of Plasma Fibrinolysis Activation Markers in Cardiovascular Disease

Gorog

2010

Journal of the American College of Cardiology

110

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The pivotal role of hypoactive endogenous fibrinolysis in the occurrence of thrombotic cardiovascular events is now well-recognized. To evaluate the diagnostic and prognostic role of impaired fibrinolysis, plasma fibrinolysis markers have been investigated in large prospective studies in both healthy individuals and patients with established coronary disease. Antigen and activity levels of components of the fibrinolytic system were measured by immunoassays, which replaced earlier global fibrinolysis tests. This review covers 45 studies in nearly 50,000 subjects, examining the association between plasma markers of fibrinolysis and coronary artery disease, to establish the usefulness of these markers in predicting future cardiovascular events. The predictive value of plasma levels of tissue-type plasminogen activator, platelet activator inhibitor-1, plasmin-antiplasmin complex, D-dimer, thrombin activatable fibrinolysis inhibitor, and lipoprotein(a) for major adverse cardiac events is highly variable and conflicting, especially after adjusting for conventional risk factors, judging from the published data in the last decade. The value of fibrinolysis activity markers is very limited in aiding diagnosis and risk stratification in the individual patient, on the basis of the weak prognostic values obtained in some studies and the lack of power in others. The physiological limitations of such markers in reflecting endogenous fibrinolysis is discussed. The emerging novel global assays of fibrinolysis will require large-scale clinical trials before their prognostic power or superiority to multiple biomarker measurements can be evaluated.

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Utility of rapid D-dimer measurement for screening of acute cardiovascular disease in the emergency setting

Abstract: Rapid measurement of D-dimer is useful for the screening of ACVD in the emergency setting.

Cited by 17 publications

References 22 publications

Factors leading to failure to diagnose acute aortic dissection in the emergency room

Factors leading to failure to diagnose acute aortic dissection in the emergency room

Plasma d-Dimer as a Useful Marker Predicts Severity of Atherosclerotic Lesion and Short-Term Outcome in Patients With Coronary Artery Disease

Prognostic Value of Plasma Fibrinolysis Activation Markers in Cardiovascular Disease

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