Key result
The D-dimer to high-sensitivity troponin T ratio accurately differentiated thoracic acute aortic syndrome from NSTEMI (AUC 0.973; OR 1.038, 95% CI 1.020-1.056, p<0.001).
Why the study?
Thoracic acute aortic syndrome and NSTEMI present similarly and are difficult to differentiate, requiring useful biomarkers for their differential diagnosis.
Does the D-dimer to high-sensitivity troponin T ratio improve the differential diagnosis of thoracic acute aortic syndrome from non-ST elevation myocardial infarction in adult patients presenting to the emergency department with acute chest pain?
Observational (n=173)
Does the D-dimer to high-sensitivity troponin T ratio improve the differential diagnosis of thoracic acute aortic syndrome from non-ST elevation myocardial infarction in adult patients presenting to the emergency department with acute chest pain?
The D-dimer to high-sensitivity troponin T ratio is a highly sensitive and specific novel biomarker for differentiating thoracic acute aortic syndrome from NSTEMI in patients presenting with acute chest pain.
May aid differentiation of thoracic aortic syndrome from NSTEMI in acute chest pain; hypothesis-generating, requires prospective validation.
Background: Thoracic acute aortic syndrome (AAS) and non-ST elevation myocardial infarction (NSTEMI) have similar clinical presentations, making them difficult to differentiate. This study aimed to identify useful biomarkers for the differential diagnosis of thoracic AAS and NSTEMI. Methods: This was a retrospective observational study. Participants: consecutive adult patients who visited the emergency department for acute chest pain between January 2015 and December 2021 diagnosed with thoracic AAS or NSTEMI. Clinical variables, including D-dimer (μg/mL) and high-sensitivity troponin T (ng/mL, hs-TnT) levels, were compared between the groups. Results: A total of 52 (30.1%) and 121 (69.9%) patients were enrolled in the thoracic AAS and NSTEMI groups, respectively. Logistic regression analysis revealed that the D-dimer to hs-TnT (D/T) ratio (odds ratio (OR), 1.038; 95% confidence interval (CI), 1.020–1.056; p < 0.001) and the thrombolysis in myocardial infarction (TIMI) score (OR, 0.184; 95% CI, 0.054–0.621; p = 0.006) were associated with thoracic AAS. The D/T ratio had an area under the receiver operating characteristic curve (AUC) of 0.973 (95% CI, 0.930–0.998), and the optimal cutoff value was 81.3 with 91.4% sensitivity and 96.2% specificity. The TIMI score had an AUC of 0.769 (95% CI, 0.644–0.812), and the optimal cutoff value was 1.5 with 96.7% sensitivity and 38.5% specificity. Conclusion: the D/T ratio may be a simple and useful parameter for differentiating thoracic AAS from NSTEMI.
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Lee et al. (2023) conducted an observational in Thoracic acute aortic syndrome and NSTEMI (n=173). D-dimer to hs-TnT (D/T) ratio was evaluated on Diagnosis of thoracic acute aortic syndrome (OR 1.038, 95% CI 1.020-1.056, p=<0.001). The D-dimer to high-sensitivity troponin T ratio accurately differentiated thoracic acute aortic syndrome from NSTEMI (AUC 0.973; OR 1.038, 95% CI 1.020-1.056, p<0.001).
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