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Kawai K, Virmani R, Finn AV. In-Stent Restenosis. Interv Cardiol Clin 2022; 11:429-443. [PMID: 36243488 DOI: 10.1016/j.iccl.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In-stent restenosis (ISR) remains a potential complication after percutaneous coronary intervention, even in the era of drug-eluting stents, and its treatment remains suboptimal. Neoatherosclerosis is an important component of the pathology of ISR and is accelerated in drug-eluting stents compared with bare-metal stents. Coronary angiography is the gold standard for evaluating the morphology of ISR, although computed tomography angiography is emerging as an alternative noninvasive modality to evaluate the presence of ISR. Drug-coated balloons and stent reimplantation are the current mainstays of treatment for ISR, and the choice of treatment should be based on clinical background and lesion morphology.
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Affiliation(s)
- Kenji Kawai
- CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Renu Virmani
- CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA
| | - Aloke V Finn
- CVPath Institute, 19 Firstfield Road, Gaithersburg, MD 20878, USA; University of Maryland, School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
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2
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Polat U, Aydinlar A, Caliskan S, Boyuk F, Unal O. The Correlation between Cardiac Enzymes and Cardiotrophin-1 Levels in Patients with Acute Coronary Syndrome. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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3
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Jiang H, Zhang H, Yang Y, Yang X. Associations of myeloperoxidase, interleukin-17A and heparin-binding EGF-like growth factor levels with in-stent restenosis after percutaneous coronary intervention: a single-centre case-control study in China. BMJ Open 2020; 10:e039405. [PMID: 33158827 PMCID: PMC7651712 DOI: 10.1136/bmjopen-2020-039405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To investigate the changes in serum myeloperoxidase (MPO), interleukin (IL)-17A and heparin-binding EGF-like growth factor (HB-EGF) levels before and after percutaneous coronary intervention (PCI), and to evaluate the associations of MPO, IL-17A and HB-EGF levels with the 1-year restenosis rate. DESIGN Case-control study. SETTINGS Xiangyang Central Hospital between January 2012 and December 2017. PARTICIPANTS Patients with coronary heart disease who underwent PCI. INTERVENTIONS Not applicable. PRIMARY AND SECONDARY OUTCOME MEASURES Not applicable. RESULTS Finally, 407 and 132 patients were included in the control and in-stent restenosis (ISR) groups, respectively. The general clinical characteristics of the patients were not significantly different between the two groups. The MPO, IL-17A and HB-EGF levels were not significantly different between the two groups at baseline but significantly increased after PCI. The ISR group showed higher levels of MPO, IL-17A and HB-EGF compared with the control group at all postoperative time points. Multivariable analysis showed that MPO, IL-17A and HB-EGF were associated with increased ISR [MPO (OR=1.003; 95% CI: 1.001 to 1.005; p=0.002), IL-17A (OR=1.015; 95% CI: 1.009 to 1.020; p<0.0001) and HB-EGF (OR=2.256; 95% CI: 1.103 to 4.009; p=0.002)]. All three factors had sensitivity and specificity ≥68% for ISR. CONCLUSIONS HB-EGF could be used for the detection of ISR after PCI and could be of use for the prediction of ISR, but the value of MPO and IL-17A might be more limited. This will have to be validated in future studies.
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Affiliation(s)
- Hua Jiang
- Department of Medical Examination, Xiangyang Central Hospital, Xiangyang, Hubei, China
| | - Hongmei Zhang
- Department of Clinical Laboratory, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Yang
- Department of Endocrinology, Xiangyang Central Hospital, Xiangyang, Hubei, China
| | - Xuezhou Yang
- Reproductive Medicine Center, Xiangyang Central Hospital, Xiangyang, Hubei, China
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4
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Mourouzis K, Oikonomou E, Siasos G, Tsalamadris S, Vogiatzi G, Antonopoulos A, Fountoulakis P, Goliopoulou A, Papaioannou S, Tousoulis D. Pro-inflammatory Cytokines in Acute Coronary Syndromes. Curr Pharm Des 2020; 26:4624-4647. [PMID: 32282296 DOI: 10.2174/1381612826666200413082353] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/01/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Over the last decades, the role of inflammation and immune system activation in the initiation and progression of coronary artery disease (CAD) has been established. OBJECTIVES The study aimed to present the interplay between cytokines and their actions preceding and shortly after ACS. METHODS We searched in a systemic manner the most relevant articles to the topic of inflammation, cytokines, vulnerable plaque and myocardial infarction in MEDLINE, COCHRANE and EMBASE databases. RESULTS Different classes of cytokines (intereleukin [IL]-1 family, Tumor necrosis factor-alpha (TNF-α) family, chemokines, adipokines, interferons) are implicated in the entire process leading to destabilization of the atherosclerotic plaque, and consequently, to the incidence of myocardial infarction. Especially IL-1 and TNF-α family are involved in inflammatory cell accumulation, vulnerable plaque formation, platelet aggregation, cardiomyocyte apoptosis and adverse remodeling following the myocardial infarction. Several cytokines such as IL-6, adiponectin, interferon-γ, appear with significant prognostic value in ACS patients. Thus, research interest focuses on the modulation of inflammation in ACS to improve clinical outcomes. CONCLUSION Understanding the unique characteristics that accompany each cytokine-cytokine receptor interaction could illuminate the signaling pathways involved in plaque destabilization and indicate future treatment strategies to improve cardiovascular prognosis in ACS patients.
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Affiliation(s)
- Konstantinos Mourouzis
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Gerasimos Siasos
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sotiris Tsalamadris
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgia Vogiatzi
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Alexios Antonopoulos
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Petros Fountoulakis
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Athina Goliopoulou
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Spyridon Papaioannou
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Oikonomou E, Mourouzis K, Fountoulakis P, Papamikroulis GA, Siasos G, Antonopoulos A, Vogiatzi G, Tsalamadris S, Vavuranakis M, Tousoulis D. Interrelationship between diabetes mellitus and heart failure: the role of peroxisome proliferator-activated receptors in left ventricle performance. Heart Fail Rev 2019; 23:389-408. [PMID: 29453696 DOI: 10.1007/s10741-018-9682-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) is a common cardiac syndrome, whose pathophysiology involves complex mechanisms, some of which remain unknown. Diabetes mellitus (DM) constitutes not only a glucose metabolic disorder accompanied by insulin resistance but also a risk factor for cardiovascular disease and HF. During the last years though emerging data set up, a bidirectional interrelationship between these two entities. In the case of DM impaired calcium homeostasis, free fatty acid metabolism, redox state, and advance glycation end products may accelerate cardiac dysfunction. On the other hand, when HF exists, hypoperfusion of the liver and pancreas, b-blocker and diuretic treatment, and autonomic nervous system dysfunction may cause impairment of glucose metabolism. These molecular pathways may be used as therapeutic targets for novel antidiabetic agents. Peroxisome proliferator-activated receptors (PPARs) not only improve insulin resistance and glucose and lipid metabolism but also manifest a diversity of actions directly or indirectly associated with systolic or diastolic performance of left ventricle and symptoms of HF. Interestingly, they may beneficially affect remodeling of the left ventricle, fibrosis, and diastolic performance but they may cause impaired water handing, sodium retention, and decompensation of HF which should be taken into consideration in the management of patients with DM. In this review article, we present the pathophysiological data linking HF with DM and we focus on the molecular mechanisms of PPARs agonists in left ventricle systolic and diastolic performance providing useful insights in the molecular mechanism of this class of metabolically active regiments.
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Affiliation(s)
- Evangelos Oikonomou
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Vasilissis Sofias 114, TK, 115 28, Athens, Greece.
| | - Konstantinos Mourouzis
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Vasilissis Sofias 114, TK, 115 28, Athens, Greece
| | - Petros Fountoulakis
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Vasilissis Sofias 114, TK, 115 28, Athens, Greece
| | - Georgios Angelos Papamikroulis
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Vasilissis Sofias 114, TK, 115 28, Athens, Greece
| | - Gerasimos Siasos
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Vasilissis Sofias 114, TK, 115 28, Athens, Greece
| | - Alexis Antonopoulos
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Vasilissis Sofias 114, TK, 115 28, Athens, Greece
| | - Georgia Vogiatzi
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Vasilissis Sofias 114, TK, 115 28, Athens, Greece
| | - Sotiris Tsalamadris
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Vasilissis Sofias 114, TK, 115 28, Athens, Greece
| | - Manolis Vavuranakis
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Vasilissis Sofias 114, TK, 115 28, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens Medical School, Vasilissis Sofias 114, TK, 115 28, Athens, Greece
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Gabbasov Z, Kozlov S, Melnikov I, Byazrova S, Saburova O, Prokofieva L, Caprnda M, Curilla E, Gaspar L, Rodrigo L, Kruzliak P, Smirnov V. Novel Biomarkers for Coronary Restenosis Occurrence After Drug-Eluting Stent Implantation in Patients With Diabetes Having Stable Coronary Artery Disease. Clin Appl Thromb Hemost 2018; 24:1308-1314. [PMID: 29716394 PMCID: PMC6714775 DOI: 10.1177/1076029618771752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of the study was to assess whether the occurrence of restenosis is associated with CD45+ platelet count and neutrophil to lymphocyte ratio in patients with type 2 diabetes mellitus (DM) after drug-eluting stent (DES) implantation for stable coronary artery disease (CAD). The study comprised 126 patients, including 55 patients with type 2 DM and stable CAD who underwent elective coronary artery stenting with DES and follow-up angiography within 6 to 12 months. Blood samples were collected from each patient on the morning of the coronary angiography procedure. The variables related to in-stent restenosis were selected by logistic regression analysis. The logistic regression analysis showed that 2 inflammatory factors, CD45+ platelet count (odds ratio [OR] = 4.51, 95% confidence interval [CI]: 1.50-13.50, P = .007) and neutrophil to lymphocyte ratio (OR = 3.09, 95% CI: 1.05-9.10, P = .04), were significantly associated with the risk of in-stent restenosis after stenting with DES in patients with stable CAD and type 2 DM. A receiver operator characteristic curve analysis indicated that the area under the curve was 0.83% (0.05%; P < .001), which showed that the logistic model had good predictive accuracy (based on CD45+ platelet count and neutrophil to lymphocyte ratio) for the risk of in-stent restenosis development in DES in patients with CAD and type 2 DM. Two novel biomarkers of restenosis, CD45+ platelet count and neutrophil to lymphocyte ratio, may be effectively used to predict in-stent restenosis after DES implantation in patients with CAD and type 2 DM.
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Affiliation(s)
- Zufar Gabbasov
- 1 Russian Cardiology Research and Production Complex, Moscow, Russian Federation
| | - Sergey Kozlov
- 1 Russian Cardiology Research and Production Complex, Moscow, Russian Federation
| | - Ivan Melnikov
- 1 Russian Cardiology Research and Production Complex, Moscow, Russian Federation.,2 Institute of Biomedical Problems of Russian Academy of Sciences, Moscow, Russian Federation
| | - Svetlana Byazrova
- 1 Russian Cardiology Research and Production Complex, Moscow, Russian Federation
| | - Olga Saburova
- 1 Russian Cardiology Research and Production Complex, Moscow, Russian Federation
| | - Lyudmila Prokofieva
- 1 Russian Cardiology Research and Production Complex, Moscow, Russian Federation
| | - Martin Caprnda
- 3 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Eduard Curilla
- 4 Department of Cardiology, East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Ludovit Gaspar
- 3 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Luis Rodrigo
- 5 Faculty of Medicne, University of Oviedo, Central University Hospital of Asturias (HUCA), Oviedo, Spain
| | - Peter Kruzliak
- 6 Department of Internal Medicine, Brothers of Mercy Hospital, Brno, Czech Republic.,7 2nd Department of Surgery, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czech Republic
| | - Vladimir Smirnov
- 1 Russian Cardiology Research and Production Complex, Moscow, Russian Federation
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7
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Gliesche DG, Hussner J, Witzigmann D, Porta F, Glatter T, Schmidt A, Huwyler J, Meyer Zu Schwabedissen HE. Secreted Matrix Metalloproteinase-9 of Proliferating Smooth Muscle Cells as a Trigger for Drug Release from Stent Surface Polymers in Coronary Arteries. Mol Pharm 2016; 13:2290-300. [PMID: 27241028 DOI: 10.1021/acs.molpharmaceut.6b00033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiovascular diseases are the leading causes of death in industrialized countries. Atherosclerotic coronary arteries are commonly treated with percutaneous transluminal coronary intervention followed by stent deployment. This treatment has significantly improved the clinical outcome. However, triggered vascular smooth muscle cell (SMC) proliferation leads to in-stent restenosis in bare metal stents. In addition, stent thrombosis is a severe side effect of drug eluting stents due to inhibition of endothelialization. The aim of this study was to develop and test a stent surface polymer, where cytotoxic drugs are covalently conjugated to the surface and released by proteases selectively secreted by proliferating smooth muscle cells. Resting and proliferating human coronary artery smooth muscle cells (HCASMC) and endothelial cells (HCAEC) were screened to identify an enzyme exclusively released by proliferating HCASMC. Expression analyses and enzyme activity assays verified selective and exclusive activity of the matrix metalloproteinase-9 (MMP-9) in proliferating HCASMC. The principle of drug release exclusively triggered by proliferating HCASMC was tested using the biodegradable stent surface polymer poly-l-lactic acid (PLLA) and the MMP-9 cleavable peptide linkers named SRL and AVR. The specific peptide cleavage by MMP-9 was verified by attachment of the model compound fluorescein. Fluorescein release was observed in the presence of MMP-9 secreting HCASMC but not of proliferating HCAEC. Our findings suggest that cytotoxic drug conjugated polymers can be designed to selectively release the attached compound triggered by MMP-9 secreting smooth muscle cells. This novel concept may be beneficial for stent endothelialization thereby reducing the risk of restenosis and thrombosis.
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Affiliation(s)
- Daniel G Gliesche
- Biopharmacy, Department of Pharmaceutical Sciences, University of Basel , 4056 Basel, Switzerland
| | - Janine Hussner
- Biopharmacy, Department of Pharmaceutical Sciences, University of Basel , 4056 Basel, Switzerland
| | - Dominik Witzigmann
- Pharmaceutical Technology, Department of Pharmaceutical Sciences, University of Basel , Basel 4056, Switzerland
| | - Fabiola Porta
- Pharmaceutical Technology, Department of Pharmaceutical Sciences, University of Basel , Basel 4056, Switzerland
| | - Timo Glatter
- Proteomics Core Facility, Biozentrum, University of Basel , Basel 4056, Switzerland
| | - Alexander Schmidt
- Proteomics Core Facility, Biozentrum, University of Basel , Basel 4056, Switzerland
| | - Jörg Huwyler
- Pharmaceutical Technology, Department of Pharmaceutical Sciences, University of Basel , Basel 4056, Switzerland
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8
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Yu J, Mehran R, Clayton T, Gibson CM, Brodie BR, Witzenbichler B, Lincoff AM, Deliargyris EN, Gersh BJ, Pocock SJ, Stone GW, Dangas GD. Prediction of 1-year mortality and impact of bivalirudin therapy according to level of baseline risk: A patient-level pooled analysis from three randomized trials. Catheter Cardiovasc Interv 2015; 87:391-400. [DOI: 10.1002/ccd.26146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/18/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Jennifer Yu
- Mount Sinai Medical Center; Cardiovascular Institute; New York New York
- Prince of Wales Hospital Clinical School; University of New South Wales; NSW Australia
| | - Roxana Mehran
- Mount Sinai Medical Center; Cardiovascular Institute; New York New York
- Cardiovascular Research Foundation; New York New York
| | - Tim Clayton
- London School of Hygiene and Tropical Medicine; London United Kingdom
| | - C. Michael Gibson
- Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Bruce R. Brodie
- LeBauer Cardiovascular Research Foundation; Greensboro North Carolina
| | | | | | | | | | - Stuart J. Pocock
- London School of Hygiene and Tropical Medicine; London United Kingdom
| | - Gregg W. Stone
- Cardiovascular Research Foundation; New York New York
- Columbia University Medical Center; New York New York
| | - George D. Dangas
- Mount Sinai Medical Center; Cardiovascular Institute; New York New York
- Cardiovascular Research Foundation; New York New York
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9
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Guerchicoff A, Stone GW, Mehran R, Xu K, Nichols D, Claessen BE, Guagliumi G, Witzenbichler B, Henriques JP, Dangas GD. Analysis of biomarkers for risk of acute kidney injury after primary angioplasty for acute ST-segment elevation myocardial infarction: Results of the HORIZONS-AMI trial. Catheter Cardiovasc Interv 2014; 85:335-42. [DOI: 10.1002/ccd.25620] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/26/2014] [Indexed: 11/06/2022]
Affiliation(s)
| | - Gregg W. Stone
- Cardiovascular Research Foundation; New York New York
- Columbia University Medical Center; New York New York
| | - Roxana Mehran
- Cardiovascular Research Foundation; New York New York
- Icahn School of Medicine at Mount Sinai; New York New York
| | - Ke Xu
- Cardiovascular Research Foundation; New York New York
| | - Dru Nichols
- Cardiovascular Research Foundation; New York New York
| | - Bimmer E. Claessen
- Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | | | | | | | - George D. Dangas
- Cardiovascular Research Foundation; New York New York
- Icahn School of Medicine at Mount Sinai; New York New York
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10
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Kikkert WJ, Claessen BE, Stone GW, Mehran R, Witzenbichler B, Brodie BR, Wöhrle J, Witkowski A, Guagliumi G, Zmudka K, Henriques JPS, Tijssen JGP, Sanidas EA, Chantziara V, Xu K, Dangas GD. D-dimer levels predict ischemic and hemorrhagic outcomes after acute myocardial infarction: a HORIZONS-AMI biomarker substudy. J Thromb Thrombolysis 2014; 37:155-64. [PMID: 23925451 DOI: 10.1007/s11239-013-0953-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
D-dimer is a product of cross linked fibrin degradation and is a measure of the amount of fibrin turnover. As such, D-dimer might be of utility in the prediction of both thrombotic and hemorrhagic events. Therefore, the aim of the present study was to evaluate whether elevated D-dimer levels on admission and at discharge could predict subsequent ischemic and hemorrhagic events in patients with acute myocardial infarction (AMI). D-dimer was measured on admission and at discharge in 461 out of a total of 3,602 patients in the HORIZONS-AMI trial, as part of the formal prespecified biomarker substudy. The predictive value for major adverse cardiovascular events (MACE) and non-CABG major bleeding after 3 year follow up was investigated by stratifying patients in groups of D-dimer level and comparing event rates using Kaplan-Meier and calculating hazard ratios using Cox proportional hazards models. D-dimer levels ≥ 0.71 μg/mL on admission were associated with an adjusted hazard ratio of 2.58 for MACE (p = 0.0014) and 4.61 for major bleeding (p = 0.0018). A discharge D-dimer level ≥ 1.26 μg/mL was associated with a higher risk for MACE by univariate analysis (HR 1.88, p = 0.037), but lost its significance after multivariate adjustment (HR 1.77, p = 0.070). High D-dimer levels on admission were associated with a higher risk of MACE and non-CABG major bleeding in STEMI patients undergoing pPCI.
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Affiliation(s)
- Wouter J Kikkert
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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