Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea.
Translational Research Center on Aging, Chonnam National University Hospital, Gwangju, Korea.
Korean J Intern Med. 2019 Nov;34(6):1263-1271. doi: 10.3904/kjim.2018.153. Epub 2019 Jan 28.
BACKGROUND/AIMS: The aim of this study was to investigate useful cardiac biomarkers in the differential diagnosis of acute pulmonary embolism (APE) with troponin elevation from acute non-ST elevation myocardial infarction (NSTEMI).
A total of 771 consecutive NSTEMI patients with D-dimer measurements and 90 patients with troponin-I (TnI) elevation out of 233 APE patients were enrolled, and cardiac biomarkers were compared.
D-dimer elevation was noted in 382 patients with NSTEMI (49.5%), and TnI elevation was noted 90 out of 233 APE patients (38.6%). Unnecessary coronary angiography was performed in 10 patients (11.1%) among 90 APE patients with TnI elevation. D-dimer was significantly elevated in APE than in NSTEMI (9.9 ± 11.6 mg/L vs. 1.8 ± 4.3 mg/L, p < 0.001), whereas TnI was significantly elevated in NSTEMI (22.4 ± 41.5 ng/mL vs. 0.7 ± 1.4 ng/mL, p < 0.001). D-dimer/TnI ratio was significantly higher in APE than in NSTEMI (50.6 ± 85.3 vs. 1.6 ± 5.7, p < 0.001). On receiver operation characteristic curve analysis, the optimal cut-off value for differentiating APE from NSTEMI was 1.12 mg/L for D-dimer (sensitivity 81.1%, specificity 70.2%), 0.72 ng/mL for TnI (sensitivity 80.6%, specificity 78.9%), and 1.82 for D-dimer/TnI ratio (sensitivity 93.3%, specificity 86.6%).
D-dimer/TnI ratio would be a simple and useful parameter for differentiating APE with cardiac troponin elevation from NSTEMI. Optimal cardiovascular imaging to identify APE should be considered in patients with D-dimer/ TnI ratio > 1.82 before performing coronary angiography to avoid unnecessary invasive procedure.
背景/目的：本研究旨在探讨肌钙蛋白升高的急性非 ST 段抬高型心肌梗死（NSTEMI）合并急性肺栓塞（APE）患者中，有哪些有用的心脏生物标志物可用于鉴别诊断。
共纳入 771 例连续的 NSTEMI 患者，其中 233 例 APE 患者中有 90 例肌钙蛋白 I（TnI）升高，测量了 D-二聚体水平；并对心脏生物标志物进行了比较。
382 例 NSTEMI 患者（49.5%）D-二聚体升高，233 例 APE 患者中有 90 例 TnI 升高。90 例 TnI 升高的 APE 患者中有 10 例（11.1%）进行了不必要的冠状动脉造影。APE 患者的 D-二聚体显著高于 NSTEMI（9.9±11.6mg/L 比 1.8±4.3mg/L，p＜0.001），而 NSTEMI 患者的 TnI 显著升高（22.4±41.5ng/ml 比 0.7±1.4ng/ml，p＜0.001）。APE 患者的 D-二聚体/TnI 比值明显高于 NSTEMI（50.6±85.3 比 1.6±5.7，p＜0.001）。在受试者工作特征曲线分析中，鉴别 APE 和 NSTEMI 的最佳截断值为 D-二聚体 1.12mg/L（敏感性 81.1%，特异性 70.2%）、TnI 0.72ng/ml（敏感性 80.6%，特异性 78.9%）和 D-二聚体/TnI 比值 1.82（敏感性 93.3%，特异性 86.6%）。
D-二聚体/TnI 比值可作为一种简单、有用的参数，用于鉴别肌钙蛋白升高的急性肺栓塞与非 ST 段抬高型心肌梗死。对于 D-二聚体/TnI 比值＞1.82 的患者，应考虑进行最佳的心血管影像学检查以明确是否存在急性肺栓塞，从而避免不必要的有创操作。
