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Impact of D-Dimer on the Prognostic Value of PARIS Thrombosis Risk Score in Acute Coronary Syndrome Patients
Sida Jia1, Deshan Yuan1, Ying Song1
1National Clinical Research Center for Cardiovascular Diseases, Fuwai hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Insights
Elevated D-dimer levels in Acute Coronary Syndrome (ACS) patients undergoing Percutaneous Coronary Intervention (PCI) independently predict long-term mortality. Incorporating D-dimer significantly enhances the prognostic accuracy of the PARIS score for adverse outcomes.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- The PARIS score is recommended for predicting coronary thrombosis events (CTE) in Acute Coronary Syndrome (ACS) patients post-Percutaneous Coronary Intervention (PCI).
- The prognostic value of D-dimer, a thrombotic biomarker, in conjunction with the PARIS score for long-term outcomes in these patients remains to be fully evaluated.
Purpose of the Study:
- To assess whether D-dimer can predict long-term adverse events in ACS patients undergoing PCI.
- To determine if D-dimer improves the prognostic capability of the PARIS score for predicting long-term adverse events.
Main Methods:
- A post-hoc analysis of a prospective cohort of 10,724 Chinese patients undergoing PCI.
- ACS patients were stratified based on baseline D-dimer levels (cutoff 0.28 µg/mL).
- Primary endpoint was all-cause death; secondary endpoints included cardiac death and CTE over 5 years, with multivariable adjustments.
Main Results:
- Higher D-dimer levels (≥ 0.28 µg/mL) were associated with significantly increased risks of 5-year all-cause death (HR=1.951) and cardiac death (HR=2.513) after adjusting for confounders.
- A trend towards a higher risk of 5-year CTE (HR=1.285) was observed in patients with higher D-dimer.
- Adding D-dimer to the PARIS score significantly improved the prediction of 5-year all-cause death and cardiac death, evidenced by increased AUC and net reclassification improvement.
Conclusions:
- D-dimer serves as an independent predictor of long-term all-cause and cardiac mortality in ACS patients undergoing PCI.
- The integration of D-dimer into risk assessment models, such as the PARIS score, enhances the prediction of long-term adverse outcomes.
Background:
Guideline-recommended PARIS thrombotic risk score predicts coronary thrombosis events (CTE) in Acute Coronary Syndrome (ACS) patients undergoing Percutaneous Coronary Intervention. We aim to evaluate whether D-dimer, a thrombotic biomarker, can predict long-term adverse events and improve the prognostic value of PARIS score.
Methods And Results:
This is a post-hoc analysis on a prospective cohort of 10,724 Chinese patients undergoing PCI. Patients who presented as ACS were included and stratified according to baseline D-dimer level (cutoff 0.28 µg/mL). The primary endpoint is all-cause death. Secondary endpoints are cardiac death and CTE. A total of 5139 ACS patients with PCI were analyzed, 2735 patients had D-dimer ≥ 0.28 µg/mL, while 2404 patients had D-dimer < 0.28 µg/mL. After adjusting for confounders, patients with higher D-dimer had significantly higher risk of 5-year all-cause death (HR = 1.951, 95% CI: 1.366-2.787) and cardiac death (HR = 2.513, 95% CI: 1.574-4.012), whilst a trend toward higher risk of 5-year CTE (HR = 1.285, 95% CI: 0.956-1.729) was observed. Compared with PARIS score alone, adding D-dimer to the model increased the area under the receiver operating characteristic curve on 5-year all-cause death (0.663-0.701, p = 0.006) and cardiac death (0.652-0.699, p = 0.015), both with significant net reclassification improvement (p < 0.001).
Conclusion:
In our cohort of ACS patients undergoing PCI, D-dimer independently predicts long-term all-cause death and cardiac death, and improves the predictive value of PARIS score over 5-year all-cause death and cardiac death.
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