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D-Dimer Levels Predict Myocardial Injury in ST-Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance
Soonuk Choi1, Woo Jin Jang2, Young Bin Song1
1Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Insights
Elevated D-dimer levels in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) indicate larger infarct size and poorer outcomes. This suggests D-dimer may signal more extensive myocardial injury.
Area of Science:
- Cardiology
- Biomarkers
- Medical Imaging
Background:
- Elevated D-dimer levels are known prognostic indicators in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI).
- The relationship between admission D-dimer levels and structural markers of myocardial injury in STEMI patients undergoing primary PCI remains unclear.
Purpose of the Study:
- To investigate the association between admission D-dimer levels and myocardial infarct size, area at risk (AAR), and myocardial salvage index (MSI) in STEMI patients treated with primary PCI.
- To determine if D-dimer levels correlate with cardiac magnetic resonance (CMR) imaging findings.
Main Methods:
- Cardiac magnetic resonance (CMR) imaging was performed on 208 patients post-primary PCI for STEMI.
- Patients were categorized into high D-dimer (>0.5 μg/mL) and low D-dimer (≤0.5 μg/mL) groups based on admission levels.
- Primary outcome was infarct size; secondary outcomes included AAR, microvascular obstruction (MVO), and MSI.
Main Results:
- Patients with high D-dimer levels exhibited significantly larger myocardial infarct size (22.3% vs. 18.8%, p=0.02) compared to those with low D-dimer levels.
- The high D-dimer group also showed a larger area at risk (AAR) (38.1% vs. 35.8%, p=0.04) and a smaller myocardial salvage index (MSI) (37.7 vs. 47.1, p=0.01).
- Multivariate analysis confirmed high D-dimer levels were associated with larger infarct size (OR 2.59) and lower MSI (OR 2.62).
Conclusions:
- In STEMI patients undergoing primary PCI, elevated admission D-dimer levels are associated with larger myocardial infarct size, greater AAR, and reduced MSI.
- Admission D-dimer levels may serve as a valuable biomarker for advanced myocardial injury in this patient population.
Objectives:
Elevated D-dimer levels on admission predict prognosis in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), but the association of D-dimer levels with structural markers of myocardial injury in these patients is unknown.
Methods:
We performed cardiac magnetic resonance (CMR) imaging in 208 patients treated with primary PCI for STEMI. CMR was performed a median of 3 days after the index procedure. Of the 208 patients studied, 75 patients had D-dimer levels above the normal range on admission (>0.5 μg/mL; high D-dimer group) while 133 had normal levels (≤0.5 μg/mL; low D-dimer group). The primary outcome was myocardial infarct size assessed by CMR. Secondary outcomes included area at risk (AAR), microvascular obstruction (MVO) area, and myocardial salvage index (MSI).
Results:
In CMR analysis, myocardial infarct size was larger in the high D-dimer group than in the low D-dimer group (22.3% [16.2-30.5] versus 18.8% [10.7-26.7]; p = 0.02). Compared to the low D-dimer group, the high D-dimer group also had a larger AAR (38.1% [31.7-46.9] versus 35.8% [24.2-45.3]; p = 0.04) and a smaller MSI (37.7 [28.2-46.9] versus 47.1 [33.2-57.0]; p = 0.01). In multivariate analysis, high D-dimer levels were significantly associated with larger myocardial infarct (OR 2.59; 95% CI 1.37-4.87; p<0.01) and lower MSI (OR 2.62; 95% CI 1.44-4.78; p<0.01).
Conclusions:
In STEMI patients undergoing primary PCI, high D-dimer levels on admission were associated with a larger myocardial infarct size, a greater extent of AAR, and lower MSI, as assessed by CMR data. Elevated initial D-dimer level may be a marker of advanced myocardial injury in patients treated with primary PCI for STEMI.
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