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

Background: Rapid and accurate methods for screening are necessary for the diagnosis of acute cardiovascular diseases (ACVD), including acute coronary syndrome (ACS), pulmonary thromboembolism, and acute aortic dissection. In this study, the utility of rapid D-dimer measurement for the screening of ACVD was evaluated. Methods and results: Consecutive 279 emergent patients in whom ACVD was suspected or not ruled out were enrolled. The median D-dimer concentration of ACVD group (1.10 mu g/ml) was significantly higher than that in the non-ACVD group (0.69 mu g/ml, p < 0.05). Sensitivity, specificity, positive predictive value, and negative predictive value of D-dimer (with cut-off level of 0.75 mu g/ml) for the discrimination of ACVD from non-ACVD was 75%, 55%, 38%, and 85%, respectively. In ACVD group, the level of D-dimer in the large vessel disease subgroup was significantly higher than that in the ACS subgroup (6.99 mu g/ml and 0.89 mu g/ml, respectively; p < 0.05). The well-balanced cut-off point for discriminating the two subgroups was D-dimer level of 5.0 mu g/ml. D-dimer (with cut-off level of 0.75 mu g/ml) showed significantly higher positive test rate for the detection of ACS in very early phase (within 2 h from the onset) compared with troponin T (p < 0.05). Conclusions: Rapid measurement of D-dimer is useful for the screening of ACVD in the emergency setting. (C) 2009 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All. rights reserved.