December 15, 1993JAMA
Quantitative Plasma D-dimer Levels Among Patients Undergoing Pulmonary Angiography for Suspected Pulmonary Embolism
Why the study?
Does quantitative plasma D-dimer level accurately predict the presence or absence of acute pulmonary embolism in patients undergoing pulmonary angiography?
Population
173 patients undergoing diagnostic pulmonary arteriography for suspected acute pulmonary embolism (PE)
Comparison
Quantitative plasma D-dimer levels measured… vs Pulmonary angiographic results
Design
Cross-sectional, Blinded comparison
Authors
Discussion
Loading...
Member takes
Implication
D-dimer <500 ng/mL may aid PE exclusion; leaves open safe avoidance of angiography pending prospective validation.
Key Points
- To determine whether low quantitative plasma D-dimer levels provide a high negative predictive value for acute pulmonary embolism in patients undergoing diagnostic pulmonary angiography.
- Conducted a blinded multicenter diagnostic study comparing quantitative plasma D-dimer levels (monoclonal antibody ELISA) to pulmonary angiography across four tertiary care institutions (N=173).
- Calculated sensitivity, specificity, and predictive values using diagnostic pulmonary angiography as the criterion standard test.
- A plasma D-dimer level below 500 ng/mL yielded a negative predictive value of 91.4% (95% CI, 76.9% to 98.2%), with abnormal angiograms detected in only 3 of 35 patients.
- Plasma D-dimer levels exceeded 500 ng/mL in 42 of 45 patients with pulmonary embolism compared to 96 of 128 patients without pulmonary embolism (P = .016).
- For a cutoff greater than 500 ng/mL, the sensitivity was 93.3% (95% CI, 81.7% to 98.6%), specificity was 25.0% (95% CI, 17.5% to 32.5%), and positive predictive value was 30.4% (95% CI, 22.8% to 38.1%).
Structured PICO
Does quantitative plasma D-dimer level accurately predict the presence or absence of acute pulmonary embolism in patients undergoing pulmonary angiography?
P
Population
173 patients undergoing diagnostic pulmonary arteriography for suspected acute pulmonary embolism (PE)
I
Intervention
Quantitative plasma D-dimer levels measured using a monoclonal antibody assay (enzyme-linked immunosorbent assay kit)
C
Comparator
Pulmonary angiographic results (criterion standard test)
O
Outcome
Sensitivity, specificity, and predictive values of quantitative plasma D-dimer levels for the diagnosis of PEsurrogate
Quantitative plasma D-dimer levels <500 ng/mL have a high negative predictive value and may help rule out acute pulmonary embolism, potentially obviating the need for pulmonary angiography in low-risk patients.
Cite This Study
Samuel Z. Goldhaber (1993) studied this question.