Key result
A D-dimer/hs-TnI ratio greater than 4.4 demonstrated excellent diagnostic accuracy (AUC 0.995, 99.5% sensitivity, 94.0% specificity) for differentiating acute pulmonary embolism from non-ST-elevation myocardial infarction.
Why the study?
To determine whether the D-dimer/hs-TnI ratio is useful in the differential diagnosis of APE and/or NSTEMI in patients presenting to the emergency department with chest pain.
Does the D-dimer/hs-TnI ratio improve the differential diagnosis of acute pulmonary embolism and non-ST-elevation myocardial infarction in patients presenting with chest pain?
Cross-Sectional (n=604)
No
Does the D-dimer/hs-TnI ratio improve the differential diagnosis of acute pulmonary embolism and non-ST-elevation myocardial infarction in patients presenting with chest pain?
The D-dimer/hs-TnI ratio is a highly accurate, easily accessible biomarker index for differentiating acute pulmonary embolism from NSTEMI in emergency department patients presenting with chest pain.
D-dimer/hs-TnI ratio may aid APE vs NSTEMI differentiation in ED chest pain; hypothesis-generating and requires prospective validation before practice change.
This study aimed to determine whether the D-dimer/high-sensitivity troponin I (hs-TnI) ratio is useful in the differential diagnosis of acute pulmonary embolism (APE) and/or non-ST-elevation myocardial infarction (NSTEMI) in patients who presented to the emergency department with chest pain. The study included 219 patients with APE and 385 patients with NSTEMI over the age of 18 who presented to the emergency department with chest pain and were diagnosed with either APE or NSTEMI. Using statistical analysis, D-dimer, hs-TnI, creatine kinase myocardial band (CK-MB) levels, D-dimer/CK-MB, and D-dimer/hs-TnI ratios were compared in patients with APE and NSTEMI. The D-dimer/hs-TnI ratio in patients with APE was found to be considerably greater than in patients with NSTEMI. Similarly, the D-dimer/CK-MB levels in patients with APE were significantly higher than in individuals with NSTEMI. Patients with APE had higher D-dimer levels, while those with NSTEMI had higher hs-TnI levels. The D-dimer/hs-TnI ratio can be useful for emergency clinicians because it is affordable, quickly calculated, and easily accessible.
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Avcı et al. (2025) conducted a cross-sectional in Acute pulmonary embolism and/or non-ST-elevation myocardial infarction (n=604). D-dimer/hs-TnI ratio vs. Individual biomarkers (hs-TnI, D-dimer, CK-MB) was evaluated on Diagnostic accuracy (Area Under the Curve) for differentiating APE from NSTEMI (AUC 0.995, 95% CI 0.99-0.99, p=<0.001). A D-dimer/hs-TnI ratio greater than 4.4 demonstrated excellent diagnostic accuracy (AUC 0.995, 99.5% sensitivity, 94.0% specificity) for differentiating acute pulmonary embolism from non-ST-elevation myocardial infarction.
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