(O-K5) The D-dimer to Troponin Ratio Is a Novel Marker for the Differential Diagnosis of Thoracic Acute Aortic Syndrome from Non-st Elevation Myocardial Infarction

Objectives: Thoracic acute aortic syndrome (AAS) and non-ST-elevation myocardial infarction (NSTEMI) have similar clinical presentations, which make it difficult to differentiate between them. This study aimed to investigate useful biomarkers for the differential diagnosis of thoracic AAS and NSTEMI.

Background: As a biomarker, troponin is associated with acute myocardial infarction (AMI), whereas D-dimer is associated with ASS. Therefore, these biomarkers can be used to diagnose or exclude each disease. However, troponin, a cardiac-specific biomarker, gets elevated not only in AMI but also in other diseases, including AAS. Also, D-dimer gets elevated in various conditions (such as pulmonary embolism, AAS, and AMI) according to secondary fibrinolysis and the intravascular activation of the coagulation system. Therefore, it may not be useful to differentiate between AAS and NSTEMI by presenting positive levels of troponin or D-dimer.

Methods: We performed a retrospective observational study. Consecutive adult patients who visited the emergency department for acute chest pain between January 2015 and December 2021 were diagnosed with thoracic AAS or NSTEMI. Clinical variables, including D-dimer (μg/mL) and high-sensitivity troponin T (ng/ml, hs-TnT) were compared between the two groups.

Results: We enrolled 52 (30.1%) and 121 (69.9%) patients in the thoracic ASS and NSTEMI groups, respectively. A 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) was 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 cut-off value was 81.3 with 91.4% sensitivity and 96.2% specificity.

Conclusions: The D/T ratio may be a simple and useful parameter for differentiating thoracic AAS from NSTEMI.

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Funding (Optional): This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.