Establishment and Validation of a Model for Differential Diagnosis between Aortic Dissection and Myocardial Infarction / 医学研究杂志

ABSTRACT

Objective Most of the clinical manifestations of aortic dissection and myocardial infarction are chest pain,which can easily lead to misdiagnosis and disastrous consequences.Therefore,this study intends to establish a differential diagnosis model and verify it in order to achieve early accurate prediction.Methods The relevant information of 200 patients with myocardial infarction and 120 pa-tients with aortic dissection diagnosed in the Second Affiliated Hospital of Zhengzhou University was collected,including age,gender,blood routine examination,electrolytes,markers of myocardial necrosis and blood coagulation function at admission.The patients were di-vided into myocardial infarction group and aortic dissection group.The independent risk factors were found out through t-test,AN OVA and binary Logistic regression analysis,and the nomogram was further drawn using R language to develop and validate the differential diag-nosis scoring table.Results The procalcitonin,prothrombin time(PT)、international normalized ratio(INR)、fibrin degradation product(FDP),D-dimer,white blood cell(WBC),percentage of neutrophil,percentage of lymphocyte,absolute value of neutrophil,absolute value of lymphocyte,C-reactive protein,cardiac troponin T(cTNT)、creatine kinase isozyme(CK-MB),systolic blood pressure of pa-tients in the two groups were statistically significant(P＜0.05),There was no significant difference in other indexes(P＞0.05).Binary Logistic regression analysis further showed that procalcitonin,D-dimer,C-reactive protein and systolic blood pressure were independent risk factors for diagnosing aortic dissection,while percentage of lymphocyte and absolute value of lymphocyte were independent risk factors for diagnosing myocardial infarction.According to the validation results of the score table developed by the nomogram,the the area under the receiver operating characteristic curve was 0.978,and the best cut-off value was 40.70 points.The sensitivity and specificity were 92.5％and 96.0％.Conclusion This study confirms that procalcitonin,D-dimer,C-reactive protein and systolic blood pressure are independent risk factors for diagnosing aortic dissection,while percentage of lymphocyte and absolute value of lymphocyte are independent risk factors for diagnosing myocardial infarction.The differential diagnosis scoring table proposed in this study can effectively differentiate patients with aortic dissection and myocardial infarction at an early stage,so as to guide further clinical diagnosis and treatment.