Predictive values of D-dimer for the long-term prognosis of acute ST-segment elevation infarction: A retrospective study in southwestern China
Qi Zhou1, Yuzhou Xue, Jian Shen
1The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Insights
High D-dimer levels in ST-segment elevation myocardial infarction (STEMI) patients predict worse outcomes. Elevated D-dimer is linked to increased in-hospital major adverse cardiovascular events and predicts long-term mortality after primary percutaneous coronary intervention.
Area of Science:
- Cardiology
- Biomarkers
- Thrombosis
Background:
- D-dimer, a fibrin degradation product, is a diagnostic marker for venous thromboembolism.
- Its prognostic significance in acute ST-segment elevation myocardial infarction (STEMI) is debated.
Purpose of the Study:
- To evaluate the predictive value of admission D-dimer levels for long-term prognosis in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
Main Methods:
- Retrospective analysis of 872 STEMI patients treated with primary PCI.
- Patients stratified into quartiles based on admission D-dimer levels.
- Follow-up for a median of 29 months.
Main Results:
- The highest D-dimer quartile (≧1.33) showed significantly higher rates of in-hospital heart failure, malignant arrhythmia, and all-cause mortality compared to the lowest quartile (≦0.33).
- High admission D-dimer (≧1.33) was an independent predictor of long-term all-cause mortality (HR: 2.53, 95% CI: 1.02-6.26, P=0.045).
Conclusions:
- Elevated D-dimer levels upon admission are associated with increased in-hospital major adverse cardiovascular events in STEMI patients.
- High D-dimer is an independent predictor of long-term all-cause mortality in this patient population.
Abstract:
D-dimer is a primary degradation product of cross-linked fibrin, and can be an effective diagnostic factor of venous thromboembolism. However, its prognostic role in patients with acute ST-segment elevation myocardial infarction (STEMI) remains controversial. This study aimed to investigate whether D-dimer has a predictive value for long-term prognosis in patients with STEMI.We retrospectively enrolled 872 STEMI patients treated with primary percutaneous coronary intervention. Patients were divided into quartiles according to their admission D-dimer increased multiple, with the highest quartile (G4) (n = 219) defined as increased multiple ≧1.33, and the lowest quartile (G1) (n = 215) as increased multiple ≦0.33.Compared with G1, higher in-hospital heart failure (40.2% vs 10.2%, P < .0001), malignant arrhythmia (14.2% vs 2.3%, P < .0001), and all-cause mortality (5.9% vs 0%, P < .0001) rates were observed in G4. After a follow-up period of 29 months, 84 patients had died. In the Cox multivariate analysis, a high admission D-dimer increased multiple (≧1.33) was found to be an independent predictor of all-cause mortality (hazards ratio: 2.53, 95% confidence interval: 1.02-6.26, P = .045).Thus, there was an association between a high D-dimer level and the increase in in-hospital major adverse cardiovascular events, such as heart failure, malignant arrhythmias, and death. High D-dimer level was also an independent predictor of long-term all-cause mortality.
