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Prognostic value of D-dimer in acute myocardial infarction complicated by heart failure with preserved ejection
Xiaoyuan Zhang1,2, Shanjie Wang1,2, Liping Sun1
1Department of Cardiology, Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, Heilongjiang, 150086, China.
Insights
High D-dimer levels predict mortality in heart failure with preserved ejection fraction (HFpEF) post-acute myocardial infarction (AMI). This biomarker is a significant predictor of death in HFpEF patients, but not in HFrEF or non-HF groups.
Area of Science:
- Cardiology
- Biomarker Research
- Clinical Outcomes
Background:
- Heart failure (HF) is a common complication following acute myocardial infarction (AMI).
- Limited contemporary data exist on the prognostic value of biomarkers in differentiating HF subtypes (HFpEF vs. HFrEF) post-AMI.
- Understanding predictors of mortality in these distinct HF populations is crucial for risk stratification.
Purpose of the Study:
- To investigate the association between D-dimer levels and all-cause mortality in patients with AMI.
- To specifically examine this association across different HF subtypes: HFpEF, HFrEF, and no HF.
- To assess the prognostic utility of D-dimer, considering other clinical risk factors.
Main Methods:
- A cohort of 4495 patients with AMI was analyzed.
- D-dimer levels were measured at baseline upon admission.
- Cox proportional hazards analysis was employed, adjusting for 18 clinical variables, to assess mortality risk over a median 1-year follow-up.
Main Results:
- In patients with HFpEF, high D-dimer levels were significantly associated with a 2.09-fold increased risk of all-cause mortality (P=0.02).
- This association remained significant even when D-dimer was analyzed as a continuous variable in the HFpEF group.
- No significant association between D-dimer levels and all-cause mortality was observed in patients with HFrEF or without HF.
Conclusions:
- Elevated D-dimer levels upon admission are a strong predictor of subsequent all-cause mortality in patients experiencing AMI complicated by HFpEF.
- D-dimer does not appear to be a significant prognostic marker for mortality in AMI patients with HFrEF or without HF.
- D-dimer measurement may aid in risk stratification for HFpEF patients post-AMI.
Aims:
The prevalence of heart failure (HF) after acute myocardial infarction (AMI) is common. Contemporary data are lacking on the prognostic utility of the measurement of biomarker for patients with AMI complicated by HF according to preserved (HFpEF) and reduced ejection fraction (HFrEF). We aim to assess the association between D-dimer levels and all-cause mortality in patients with AMI complicated by different HF subtypes during hospitalization in the context of other risk factors.
Methods And Results:
We enrolled 4495 patients with AMI with complete clinical and laboratory variable assessments in this cohort. D-dimer levels were measured on admission immediately at baseline. We used Cox proportional hazards analysis to assess this association accounting for 18 relevant clinical variables. During the index hospitalization, 589 patients with AMI developed HFpEF, 513 patients with AMI developed HFrEF, and 3393 patients with AMI did not develop HF. The patients were divided into HFpEF, HFrEF, and non-HF groups accordingly. The median length of follow-up was 1 year (range: 1 to 24 months). During the whole follow-up, 58 (15.5%), 107 (27.9%), and 96 (4.2%) of the patients experienced death event in HFpEF, HFrEF, and non-HF groups, respectively. In each group, the patients were divided into high or low D-dimer levels according to D-dimer concentration (145 ng/mL). In the fully adjusted model, the risk of all-cause mortality of those patients with high D-dimer levels was 2.09 [95% confidence intervals (CI): 1.08 to 4.02, P = 0.02] times as high as the risk of patients with low D-dimer levels in HFpEF group. When analysing D-dimer as a continuous variable, this associations still existed. But there was no significant association between D-dimer concentration and all-cause mortality in HFrEF [hazard ratio (HR): 1.25, CI: 0.76 to 2.04, P = 0.37] or non-HF (HR: 1.56, CI: 0.98 to 2.47, P = 0.06), respectively, after fully adjustment for other key clinical variables.
Conclusions:
High D-dimer levels on admission were found to be strongly associated with the subsequent cumulative incidence of all-cause mortality in patients with AMI complicated by HFpEF.
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