Is this heart attack worse than the other? Use of D-dimer levels in Non-ST Elevation Myocardial Infarction

Background: Non-ST Segment Elevation Myocardial Infarction (NSTEMI) is an elusive diagnosis in patients presenting with chest pain in the emergency department (ED). The role of D-dimer in the diagnosis used as an additional tool is unclear. Objective: The present study is designed to investigate the role of D-dimer levels in the initial management of patients diagnosed with Troponin-positive NSTEMI admitted to the University-based ED. Methods: A prospective, observational study was conducted in the ED of a major tertiary university-affiliated center in the six-month study period. Fifty-eight patients diagnosed with NSTEMI in the six-month study period were enrolled in the study. All patients were observed for 12 hours in ED and serial ECGs were obtained. Creatinin Phospokinase-MB fraction (CK-MB), Myoglobin and Troponin-T were measured three times for each patient. Patients with elevated Troponin-T levels were diagnosed as NSTEMI and then D-dimer levels were assayed. Results: Mean age of the 58 patients was 69.7±11.8 and 34 (58.6%) were male. D-dimer levels were found high in 35 (60.3%) of 58 patients diagnosed with NSTEMI. Coronary angiography (CAG) was performed in 46 patients (79.3%) and signifcant coronary atherosclerosis was detected in 44 (95.6%) of them. Mean D-dimer levels of patients with only 1 or 2 involved vessels were found to be lower than those with 3 or more involved vessels (p=0.001). Conclusion: D-dimer levels may have a role in predicting more severe coronary artery disease in the emergency setting in patients presenting with chest pain and NSTEMI.