D-dimer is helpful for differentiating acute aortic dissection and acute pulmonary embolism from acute myocardial infarction.

INTRODUCTION: Acute aortic dissection (AAD), acute pulmonary embolism (PE) and acute myocardial infarction (AMI) are all emergent diseases with acute chest pain. However, it is sometimes difficult to diagnose these diseases by symptoms, ECG changes and/or cardiac biomarkers, especially immediately after onset. Because these diseases are all thrombogenic diseases, we considered that D-dimer could be helpful to differentiate these diseases. The purpose of this research was to define the D-dimer value for discrimination between AAD, PE and AMI.
METHODS: Plasma D-dimer values of a consecutive series of 35 AAD, 22 PE and 206 AMI patients on admission were analyzed retrospectively.
RESULTS: The D-dimer values of patients with AAD (32.9 ± 66.7 g/ml, p<0.001) and PE (28.5 ± 23.6 g/ ml, p<0.001) were significantly higher than those of AMI patients (2.1 ± 3.7 g/ml). A cutoff value of 5.0 g/ ml was effective in distinguishing AAD and PE from AMI, with a sensitivity of 68% and a specificity of 90%.
CONCLUSIONS: Our study showed the possibility that D-dimer could enable faster diagnosis and treatment of AAD, PE and AMI patients. We expect that the D-dimer test will be used more often for screening patients with possible AAD, PE or AMI in the emergency room. We would recommend contrast computed tomography first, not coronary angiography, in a patient with a D-dimer level higher than 5.0 g/ml using our diagnostic kit.