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D-dimer level predicts in-hospital adverse outcomes after primary PCI for ST-segment elevation myocardial infarction
Dong Huang1, Wei Gao1, Runda Wu1
1Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
Insights
Elevated D-dimer levels predict worse outcomes in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PCI). This includes patients with thrombus or no-reflow, highlighting D-dimer
Area of Science:
- Cardiology
- Biomarkers
- Acute Coronary Syndromes
Background:
- D-dimer's prognostic role in ST-segment elevation myocardial infarction (STEMI) is debated, especially in patients with angiographically evident thrombus or no-reflow.
- Primary percutaneous coronary intervention (PCI) is the standard treatment for STEMI.
Purpose of the Study:
- To investigate the association between D-dimer levels and in-hospital outcomes in STEMI patients undergoing primary PCI.
- To evaluate D-dimer's prognostic value in specific subgroups, including those with angiographically evident thrombus or no-reflow.
Main Methods:
- Retrospective analysis of 1165 STEMI patients treated with primary PCI between January 2008 and December 2018.
- Assessment of in-hospital major adverse cardiovascular events (MACE), peak troponin T, NT-proBNP, left ventricular ejection fraction (LVEF), and hospitalization duration.
- Stratification of patients based on D-dimer levels (≥0.8 mg/L vs. normal).
Main Results:
- Patients with increased D-dimer (19.2%) were older, more often female, and non-smokers.
- Increased D-dimer was associated with higher peak troponin T and NT-proBNP levels, lower LVEF, and longer hospitalization.
- The increased D-dimer group had a significantly higher risk of in-hospital MACE (12.1% vs. 1.5%), independent of angiographic findings like thrombus or no-reflow.
Conclusions:
- Elevated D-dimer is an independent predictor of in-hospital MACE in STEMI patients undergoing primary PCI.
- D-dimer provides prognostic information even in patients with angiographically evident thrombus or no-reflow phenomenon.
- The study confirms D-dimer's utility in risk stratification for STEMI patients receiving primary PCI.
Background:
Use of D-dimer for prognostication of patients with ST-segment elevation myocardial infarction (STEMI) remains controversial and undefined among those with angiographically evident thrombus or no-reflow phenomenon.
Methods:
We retrospectively analyzed consecutive STEMI patients who received primary percutaneous coronary intervention (PCI) at Zhongshan Hospital Fudan University from January 2008 to December 2018. Outcomes were in-hospital major adverse cardiovascular events (MACE: cardiac death, non-fatal acute myocardial infarction, re-vascularization and stroke), peak troponin T and NT-proBNP levels, left ventricular ejection fraction (LVEF) and hospitalization duration.
Results:
Among 1165 patients, those with increased (≥0.8 mg/L, n = 224, 19.2%) vs. normal (n = 941, 80.8%) D-dimer level were older; more often women and non-smokers. Increased D-dimer group had similar frequency of AET (58.7% vs. 62.1%, P = .353), more frequently no-reflow phenomenon (13.1% vs. 18.8%, P = .028), higher peak values of troponin T (3.5 [0.9-7.0] vs. 4.5 [1.8-8.7], P = .001) and NT-proBNP (903.3 [532.3-2098.5] vs. 2070.0 [859.1-4378.0], p < .001). In increased D-dimer group, LVEF (53.3 ± 8.3 vs. 48.8 ± 9.8, P < .001) was lower, hospitalization was longer (8.0 ± 4.9 vs. 10.5 ± 6.9 days, P < .001) and risk of developing in-hospital MACE (1.5% vs. 12.1%, P < .001) was greater. D-dimer level was an independent risk factor for MACE (OR 8.408, 95%CI 4.065-17.392, P < .001), including the angiographically evident thrombus (OR 6.939, 95% CI 2.944-16.355, P < .001) and the no-reflow (OR 8.114, 95% CI 1.598-41.196, P = .012) subgroups.
Conclusions:
Increased D-dimer level was an independent risk factor for in-hospital MACE in STEMI patients undergoing primary PCI, including those with angiographically evident thrombus and no-reflow phenomenon. D-dimer was not associated to no-reflow phenomenon in STEMI patients.
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