Exploring the Role of D-Dimer-to-Troponin Ratio in Differentiating Between Acute Pulmonary Embolism and Non-ST Elevation Myocardial Infarction

Background Acute pulmonary embolism (APE) and non-ST elevation myocardial infarction (NSTEMI) are two of the most common cardiovascular emergencies with overlapping clinical presentations, which frequently produce diagnostic dilemmas. Both APE and NSTEMI share elevation in D-dimer and troponin I, rendering them less specific when utilized singly. Objective This study aimed to investigate whether the ratio of D-dimer to troponin I could serve as a discriminative biomarker for differentiating between APE and NSTEMI. Methods An observational cross-sectional analysis was performed in 40 patients with confirmed APE and NSTEMI cases. Demographic factors and laboratory variables (D-dimer, troponin I, and estimated D-dimer-to-troponin ratio) were recorded. Statistical analysis was conducted with IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Continuous data were reported as mean±SD, and the categorical data were given as frequencies and percentages. Comparisons between groups were made using t-tests and correlation with Pearson's coefficient, and p<0.05 was considered significant. Results Patients' mean age was 55.9±8.8 years for APE and 52.4±6.3 years for NSTEMI. APE patients showed much higher ratios of D-dimer to troponin (42.1±34.7) than NSTEMI patients (0.36±0.49; p<0.001). Sex-related differences were not statistically significant in both groups. Troponin I was negatively correlated with the ratio in APE (r=-0.590; p<0.001), while D-dimer was significantly correlated with the ratio in NSTEMI (r=0.798; p<0.001) in correlation analysis. Conclusion The D-dimer-to-troponin ratio well differentiates between APE and NSTEMI, reflecting their unique pathophysiologic mechanisms. This ratio can perhaps offer clinicians an easy, inexpensive adjunct to enhance early diagnostic precision and direct proper treatment strategies.