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D-dimer levels predict ischemic and hemorrhagic outcomes after acute myocardial infarction: a HORIZONS-AMI biomarker
Wouter J Kikkert1, Bimmer E Claessen, Gregg W Stone
1Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Elevated D-dimer levels on admission in acute myocardial infarction (AMI) patients predict major adverse cardiovascular events (MACE) and bleeding. D-dimer is a key marker for fibrin turnover and patient risk stratification.
Area of Science:
- Cardiology
- Biomarkers
- Thrombosis
Background:
- D-dimer indicates fibrin degradation and turnover.
- It may predict both thrombotic and hemorrhagic events.
Purpose of the Study:
- To assess if D-dimer levels on admission and discharge predict subsequent ischemic and hemorrhagic events in acute myocardial infarction (AMI) patients.
Main Methods:
- D-dimer measured on admission and discharge in 461 AMI patients (HORIZONS-AMI trial).
- Kaplan-Meier and Cox proportional hazards models used to evaluate predictive value for major adverse cardiovascular events (MACE) and major bleeding over 3 years.
Main Results:
- Admission D-dimer ≥ 0.71 μg/mL associated with significantly higher adjusted risk for MACE (HR 2.58) and major bleeding (HR 4.61).
- Discharge D-dimer ≥ 1.26 μg/mL showed univariate association with MACE risk, but lost significance after multivariate adjustment.
- High admission D-dimer levels predict MACE and major bleeding in STEMI patients undergoing primary PCI.
Conclusions:
- Elevated D-dimer on admission is a strong predictor of MACE and major bleeding in AMI patients.
- D-dimer levels on admission are valuable for risk stratification in STEMI patients undergoing primary PCI.
Abstract:
D-dimer is a product of cross linked fibrin degradation and is a measure of the amount of fibrin turnover. As such, D-dimer might be of utility in the prediction of both thrombotic and hemorrhagic events. Therefore, the aim of the present study was to evaluate whether elevated D-dimer levels on admission and at discharge could predict subsequent ischemic and hemorrhagic events in patients with acute myocardial infarction (AMI). D-dimer was measured on admission and at discharge in 461 out of a total of 3,602 patients in the HORIZONS-AMI trial, as part of the formal prespecified biomarker substudy. The predictive value for major adverse cardiovascular events (MACE) and non-CABG major bleeding after 3 year follow up was investigated by stratifying patients in groups of D-dimer level and comparing event rates using Kaplan-Meier and calculating hazard ratios using Cox proportional hazards models. D-dimer levels ≥ 0.71 μg/mL on admission were associated with an adjusted hazard ratio of 2.58 for MACE (p = 0.0014) and 4.61 for major bleeding (p = 0.0018). A discharge D-dimer level ≥ 1.26 μg/mL was associated with a higher risk for MACE by univariate analysis (HR 1.88, p = 0.037), but lost its significance after multivariate adjustment (HR 1.77, p = 0.070). High D-dimer levels on admission were associated with a higher risk of MACE and non-CABG major bleeding in STEMI patients undergoing pPCI.
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