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Zhou X, Wang D, Jin Y, Gong M, Lin Q, He Y, Huang W, Shan P, Liang D. Sex differences in the association between D-dimer and the incidence of acute kidney injury in patients admitted with ST-segment elevation myocardial infarction: a retrospective observational study. Intern Emerg Med 2024; 19:91-98. [PMID: 37837488 DOI: 10.1007/s11739-023-03443-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/20/2023] [Indexed: 10/16/2023]
Abstract
Identifying the predictors of acute kidney injury (AKI) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains important. We aimed to investigate the predictive value of D-dimer levels for the incidence of AKI in such a population, with particular attention paid to sex differences. A total of 2668 patients with STEMI who underwent PPCI were retrospectively included in this study and divided into quartiles according to their plasma D-dimer levels upon admission (Q1: < 0.36; Q2: 0.36-0.67; Q3: 0.68-1.17; Q4: > 1.17 mg/L). The primary endpoint was the occurrence of AKI during hospitalization. AKI was observed in 503 (18.8%) patients. The mean age of the patients was 63.0 ± 13.2 years, 2155 (80.8%) of whom were men. Multivariate analysis indicated that higher D-dimer levels were associated with a significantly increased risk of AKI (Q4 vs. Q1: OR: 1.57; 95% CI 1.11-2.23; P = 0.011). However, the prognostic effect of D-dimer was only observed in male patients (Q4 vs. Q1: OR: 2.07; 95% CI 1.37-3.13; P < 0.001), not in female patients (Q4 vs. Q1: OR: 0.72; 95% CI 0.37-1.41; P = 0.342) (P for interaction = 0.003). We demonstrated a notable sex difference in the association between D-dimer level upon admission and AKI in a large STEMI patient sample. A higher D-dimer level was associated with an increased risk of AKI in male patients but not in female patients.
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Affiliation(s)
- Xi Zhou
- Department of Cardiac Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dingzhou Wang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, China
| | - Youkai Jin
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, China
| | - Mengge Gong
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, China
| | - Qingcheng Lin
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, China
| | - Yanlei He
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, China
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, China
| | - Peiren Shan
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, China.
| | - Dongjie Liang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, China.
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Zagrapan B, Klopf J, Celem ND, Brandau A, Rossi P, Gordeeva Y, Szewczyk AR, Liu L, Ahmadi-Fazel D, Najarnia S, Fuchs L, Hayden H, Loewe C, Eilenberg W, Neumayer C, Brostjan C. Diagnostic Utility of a Combined MPO/D-Dimer Score to Distinguish Abdominal Aortic Aneurysm from Peripheral Artery Disease. J Clin Med 2023; 12:7558. [PMID: 38137627 PMCID: PMC10743483 DOI: 10.3390/jcm12247558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) and peripheral artery disease (PAD) share pathophysiological mechanisms including the activation of the fibrinolytic and innate immune system, which explains the analysis of D-dimer and myeloperoxidase (MPO) in both conditions. This study evaluates the diagnostic marker potential of both variables separately and as a combined MPO/D-dimer score for identifying patients with AAA versus healthy individuals or patients with PAD. Plasma levels of MPO and D-dimer were increased in PAD and AAA compared to healthy controls (median for MPO: 13.63 ng/mL [AAA] vs. 11.74 ng/mL [PAD] vs. 9.16 ng/mL [healthy], D-dimer: 1.27 μg/mL [AAA] vs. 0.58 μg/mL [PAD] vs. 0.38 μg/mL [healthy]). The combined MPO/D-dimer score (median 1.26 [AAA] vs. -0.19 [PAD] vs. -0.93 [healthy]) showed an improved performance in distinguishing AAA from PAD when analysed using the receiver operating characteristic curve (area under the curve) for AAA against the pooled data of healthy controls + PAD: 0.728 [MPO], 0.749 [D-dimer], 0.801 [score]. Diagnostic sensitivity and specificity ranged at 82.9% and 70.2% (for score cut-off = 0). These findings were confirmed for a separate collective of AAA patients with 35% simultaneous PAD. Thus, evaluating MPO together with D-dimer in a simple score may be useful for diagnostic detection and the distinction of AAA from athero-occlusive diseases like PAD.
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Affiliation(s)
- Branislav Zagrapan
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Johannes Klopf
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Nihan Dide Celem
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Annika Brandau
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Patrick Rossi
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Yulia Gordeeva
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Alexandra Regina Szewczyk
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Linda Liu
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Diana Ahmadi-Fazel
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Sina Najarnia
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Lukas Fuchs
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Hubert Hayden
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Christian Loewe
- Department for Bioimaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria;
| | - Wolf Eilenberg
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Christoph Neumayer
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
| | - Christine Brostjan
- Department of General Surgery, Division of Vascular Surgery, University Hospital Vienna, Medical University of Vienna, 1090 Vienna, Austria; (B.Z.); (J.K.); (N.D.C.); (A.B.); (P.R.); (Y.G.); (A.R.S.); (L.L.); (D.A.-F.); (S.N.); (L.F.); (H.H.); (W.E.); (C.N.)
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Jiang Y, Zhu Y, Xiang Z, Sasmita BR, Wang Y, Ming G, Chen S, Luo S, Huang B. The prognostic value of admission D-dimer level in patients with cardiogenic shock after acute myocardial infarction. Front Cardiovasc Med 2023; 9:1083881. [PMID: 36698952 PMCID: PMC9868698 DOI: 10.3389/fcvm.2022.1083881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background Shock is associated with the activation of the coagulation and fibrinolytic system, and D-dimer is the degradation product of cross-linked fibrin. However, the prognostic value of D-dimer in patients with cardiogenic shock (CS) after acute myocardial infarction (AMI) remains unclear. Methods We retrospectively analyzed the data of consecutive patients with CS complicating AMI. The primary endpoint was 30-day mortality and the secondary endpoint was the major adverse cardiovascular events (MACEs) including 30-day all-cause mortality, ventricular tachycardia/ventricular fibrillation, atrioventricular block, gastrointestinal hemorrhage, and non-fatal stroke. Restricted cubic spline (RCS) analyses were performed to assess the association between admission D-dimer and outcomes. A multivariable Cox regression model was performed to identify independent risk factors. The risk predictive potency with D-dimer added to the traditional risk scores was evaluated by C-statistics and the net reclassification index. Results Among 218 patients with CS complicating AMI, those who died during the 30-day follow-up presented with worse baseline characteristics and laboratory test results, including a higher level of D-dimer. According to the X-tile program result, the continuous plasma D-dimer level was divided into three gradients. The 30-day all-cause mortality in patients with low, medium, and high levels of D-dimer were 22.4, 53.3, and 86.2%, respectively (p < 0.001 for all). The 30-day incidence of MACEs was 46.3, 77.0, and 89.7%, respectively (p < 0.001). In the multivariable Cox regression model, the trilogy of D-dimer level was an independent risk predictor for 30-day mortality (median D-dimer cohort: HR 1.768, 95% CI 0.982-3.183, p = 0.057; high D-dimer cohort: HR 2.602, 95% CI 1.310-5.168, p = 0.006), a similar result was observed in secondary endpoint events (median D-dimer cohort: HR 2.012, 95% CI 1.329-3.044, p = 0.001; high D-dimer cohort: HR 2.543, 95% CI 1.452-4.453, p = 0.001). The RCS analyses suggested non-linear associations of D-dimer with 30-day mortality. The enrollment of D-dimer improved risk discrimination for all-cause death when combined with the traditional CardShock score (C-index: 0.741 vs. 0.756, p difference = 0.004) and the IABP-SHOCK II score (C-index: 0.732 vs. 0.754, p difference = 0.006), and the GRACE score (C-index: 0.679 vs. 0.715, p difference < 0.001). Similar results were acquired after logarithmic transformed D-dimer was included in the risk score. The improvements in reclassification which were calculated as additional net reclassification index were 7.5, 8.6, and 12.8%, respectively. Conclusion Admission D-dimer level was independently associated with the short-term outcome in patients with CS complicating AMI and addition of D-dimer brought incremental risk prediction value to traditional risk prediction scores.
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Yang J, Zhao Y, Li Y, Tang J, Zhao Y. D-dimer to Creatinine Ratio: A Novel Biomarker Associated with Gensini Score in ST-Segment Elevation Myocardial Infarction Patients. Clin Appl Thromb Hemost 2022; 28:10760296221099938. [PMID: 35535397 PMCID: PMC9096193 DOI: 10.1177/10760296221099938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective We propose for the first time that D-dimer to creatinine ratio (DCR) may serve as a new clinical biomarker and explore its association with ST-segment elevation myocardial infarction (STEMI). Methods 347 STEMI patients with complete D-dimer and creatinine were included in the analysis. According to the median of DCR value, patients were divided into the lower DCR group (DCR < 1.402, n = 173) and the higher DCR group (DCR ≥ 1.402, n = 174), and the differences between the two groups were compared. In addition, patients were divided into four groups according to the quartiles of Gensini score: Group 1(Gensini score ≤ 34, n = 88); Group 2(34 < Gensini score ≤ 65, n = 88); Group 3(65 < Gensini score ≤100, n = 87); Group 4(Gensini score ＞100, n = 84). Multivariate linear and multivariate logistic regression analyzes were performed to determine independent predictors of the Gensini score. Results High DCR group had higher Gensini score compared with the low DCR group ( P < .05). DCR was positively correlated with Gensini score (r = 0.493, P < .001). Multiple linear regression analysis showed that Previous MI (r = 11.312, P = .035) and DCR (r = 5.129, P < .001) were independent risk factors associated with the Gensini score. Multivariate logistic regression analysis showed that, compared to Group 1, DCR was an independent risk factor in Group 2, Group 3, Group 4 ( P < .001). Conclusions As a new and useful clinical biomarker, DCR was positively correlated with coronary Gensini score in STEMI patients.
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Affiliation(s)
- Jiaojiao Yang
- Department of Gastroenterology, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Preparatory Stage), Shanghai, China
- Department of Gastroenterology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Yingjie Zhao
- Department of Cardiology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Li
- The Fourth Department of Cardiology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jianmin Tang
- Department of Cardiology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yipin Zhao
- Department of Cardiology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Chen R, Liu C, Zhou P, Li J, Zhou J, Song R, Liu W, Chen Y, Song L, Zhao H, Yan H. Prognostic Value of Age-Adjusted D-Dimer Cutoff Thresholds in Patients with Acute Coronary Syndrome Treated by Percutaneous Coronary Intervention. Clin Interv Aging 2022; 17:117-128. [PMID: 35173426 PMCID: PMC8841267 DOI: 10.2147/cia.s347168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/16/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Associations between D-dimer and outcomes of patients with acute coronary syndrome (ACS) remain controversial. Using age-adjusted D-dimer cutoff thresholds improve the diagnostic accuracy for thrombotic diseases. This study aimed to investigate the prognostic value of age-adjusted D-dimer in ACS patients treated by percutaneous coronary intervention (PCI). METHODS A total of 3972 consecutive patients with ACS treated by PCI were retrospectively recruited. The basal age-adjusted D-dimer threshold was 500 ng/mL and was calculated as age × 10 in patients older than 50 years. Cox regression was used for outcome analysis. C-index, net reclassification index (NRI), and integrated discrimination improvement (IDI) were calculated to assess the additional prognostic value of age-adjusted D-dimer when combined with established clinical risk factors. The primary outcome was all-cause death. RESULTS During a median follow-up of 720 days, a total of 225 deaths occurred. High D-dimer level, as defined by age-adjusted thresholds, was an independent predictor for all-cause death (hazard ratio [HR]: 1.75, 95% confidence interval [CI]: 1.32-2.31, P < 0.001), cardiac death (HR: 1.84, 95% CI: 1.30-2.60, P = 0.001), and MACE (HR: 1.48, 95% CI: 1.19-1.83, P < 0.001). Sensitivity and subgroup analysis showed that high D-dimer levels were constantly associated with worse outcomes across common risk factors and comorbidities. Besides, age-adjusted elevation of D-dimer significantly improved the risk predictions for all-cause death when added to the model of established risk factors (C-index: 0.846 vs 0.838, Δ C-index: 0.008, 95% CI: 0.001-0.015, Pdifference = 0.027; NRI: 0.645, 95% CI: 0.464-0.826, P < 0.001; IDI: 0.008, 95% CI: 0.001-0.017, P = 0.048). CONCLUSION In ACS patients treated by PCI, age-adjusted elevation of D-dimer was an independent predictor for adverse outcomes and improved the risk predictions for long-term mortality.
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Affiliation(s)
- Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People’s Republic of China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People’s Republic of China
- Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Ruoqi Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Weida Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Hongbing Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People’s Republic of China
- Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
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Biccirè FG, Farcomeni A, Gaudio C, Pignatelli P, Tanzilli G, Pastori D. D-dimer for risk stratification and antithrombotic treatment management in acute coronary syndrome patients: asystematic review and metanalysis. Thromb J 2021; 19:102. [PMID: 34922573 PMCID: PMC8684263 DOI: 10.1186/s12959-021-00354-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/29/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Data on the prognostic role of D-dimer in patients with acute coronary syndrome (ACS) are controversial. Our aim was to summarize current evidence on the association between D-dimer levels and short/long-term poor prognosis of ACS patients. We also investigated the association between D-dimer and no-reflow phenomenon. METHODS Systematic review and metanalysis of observational studies including ACS patients and reporting data on D-dimer levels. PubMed and SCOPUS databases were searched. Data were combined with hazard ratio (HR) and metanalysed. The principal endpoint was a composite of cardiovascular events (CVEs) including myocardial infarction, all-cause and cardiovascular mortality. RESULTS Overall, 32 studies included in the systematic review with 28,869 patients. Of them, 6 studies investigated in-hospital and 26 studies long-term outcomes. Overall, 23 studies showed positive association of high D-dimer levels with CVEs. D-dimer levels predicted poor prognosis in all studies reporting in-hospital outcomes. Five studies satisfied inclusion criteria and were included in the metanalysis, with a total of 8616 patients. Median follow-up was 13.2 months with 626 CVEs. The pooled HR for D-dimer levels and CVEs was 1.264 (95% CI 1.134-1.409). Five out of 7 studies (4195 STEMI patients) investigating the association between D-dimer levels and no-reflow showed a positive correlation of D-dimer levels with no-reflow. CONCLUSIONS In patients with ACS, D-dimer was associated with higher in-hospital and short/long-term complications. D-dimer was also higher in patients with no-reflow phenomenon. The use of D-dimer may help to identify patients with residual thrombotic risk after ACS. TRIAL REGISTRATION The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews: CRD42021267233 .
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Affiliation(s)
- Flavio Giuseppe Biccirè
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
- Department of General and Specialized Surgery "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Alessio Farcomeni
- Department of Economics and Finance, University of Rome "Tor Vergata", Via Columbia 2, 00133, Rome, Italy
| | - Carlo Gaudio
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Gaetano Tanzilli
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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Shakhmatova OO, Komarov AL, Korobkova VV, Titaeva EV, Dobrovolskiy AB, Yarovaya EB, Shuleshova AG, Panchenko EP. Relationship between the D-dimer and von Willebrand factor levels and the development of gastrointestinal bleeding in patients with stable coronary artery disease: data from the registry of long-term antithrombotic therapy REGATTA-1. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-3022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To study the role of von Willebrand factor (VWF) and D-dimer (DD) as predictors of upper gastrointestinal bleeding (GIB) in patients with stable coronary artery disease (CAD).Material and methods. The study included patients with stable CAD who are members of the prospective registry of long-term antithrombotic therapy (REGATTA-1) (ClinicalTrials.gov Identifier: NCT04347200). The primary endpoints were actionable GIBs (Bleeding Academic Research Consortium type 2-5). Cut-off points for DD and VWF were determined by ROC analysis. The predictive significance of an increase in VWF and DD was assessed by the logistic regression.Results. The study included 408 patients (men, 77,5%; mean age, 61,3±10,8 years). The median follow-up period was 2,5 [1,1-14,7] years. DD was determined in all patients, including 36 patients with GIB, while VWF — in 169 patients (28 patients with GIB). An increase in DD >928 ng/ml was an independent predictor of GIB, including taking into account clinical risk factors (odds ratio (OR), 3,26 [95% confidence interval (CI), 1,43-7,42] (p=0,0047), or the previously developed REGATTA scale score (OR, 3,73, 95% CI: 1,65-8,43 (p=0,0015)). VWF >105% was also an independent predictor of GIB (OR, 14,02; 95% CI: 1,41-139,42 (p=0,023)); in the REGATTA scale model — OR 11,3, 95% CI: 1,43-88,83 (p=0,021). The increase in both markers was most unfavorable, since the proportion of those with GIB was 41,4%, while among patients with normal DD and increased VWF — 14,9%, and with low values of both markers — 0%. OR of GIB in patients with an increase in both markers was 4,1 (95% CI: 1,6-10,3 (p=0,003)).Conclusion. In patients with stable CAD, an increase in VWF and DD was associated with an increase in GIB risk regardless of the presence of clinical risk factors.
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Affiliation(s)
| | | | | | | | | | - E. B. Yarovaya
- National Medical Research Center of Cardiology;
Lomonosov Moscow State University
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8
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Bicciré FG, Pastori D, Tanzilli A, Pignatelli P, Viceconte N, Barillà F, Versaci F, Gaudio C, Violi F, Tanzilli G. Low serum albumin levels and in-hospital outcomes in patients with ST segment elevation myocardial infarction. Nutr Metab Cardiovasc Dis 2021; 31:2904-2911. [PMID: 34344545 DOI: 10.1016/j.numecd.2021.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/22/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Low serum albumin (SA) is associated with an increased risk of long-term adverse events (AEs) among patients with chronic coronary syndromes. Its prognostic role in patients with ST-elevation myocardial infarction (STEMI) is less clear. To investigate the association between low SA and in-hospital AEs in STEMI patients. METHODS AND RESULTS Multicenter retrospective cohort study of 220 STEMI patients undergoing primary percutaneous coronary intervention within 12 h from the onset of symptoms. Hypoalbuminemia was defined by serum SA <35 g/L. SA. In-hospital AEs were defined as cardiogenic shock, resuscitated cardiac arrest and death. Median SA was 38 (IQR 35.4-41.0) g/L and 37 (16.8%) patients showed hypoalbuminemia (<35 g/L) on admission. Patients with hypoalbuminemia were older, more frequently women and diabetics, prior CAD and HF. Furthermore, they showed lower hemoglobin levels and impaired renal function. At multivariable logistic regression analysis, diabetes (odds ratio [OR]:4.59, 95% confidence interval [CI] 1.71-12.28, p = 0.002) and haemoglobin (OR:0.52, 95%CI 0.37-0.72, p < 0.001) were associated with low SA. In a subgroup of 132 patients, SA inversely correlated with D-Dimer (rS -0.308, p < 0.001). Globally, twenty-eight (14.6%) AEs were recorded. Hypoalbuminemia (OR:3.43, 95%CI 1.30-9.07, p = 0.013), high-sensitive (HS)-Troponin peak above median (OR:5.41, 95%CI 1.99-14.7, p = 0.001), C-reactive protein (CRP) peak above median (OR:6.03, 95%CI 2.02-18.00, p = 0.001), and in-hospital infection (OR:3.61, 95%CI 1.21-10.80, p = 0.022) were associated with AEs. CONCLUSION Low SA levels are associated with worse in-hospital AEs in STEMI patients, irrespective of HS-troponin and CRP plasma levels. Our findings suggest that low SA may contribute to the pro-thrombotic phenotype of these patients.
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Affiliation(s)
- Flavio Giuseppe Bicciré
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | | | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy; Clinica Mediterranea, Naples, Italy
| | - Nicola Viceconte
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Francesco Barillà
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | | | - Carlo Gaudio
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
| | - Francesco Violi
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy; Clinica Mediterranea, Naples, Italy.
| | - Gaetano Tanzilli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy
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Li JF, Lin ZW, Chen CX, Liang SQ, Du LL, Qu X, Gao Z, Huang YH, Kong ST, Chen JX, Sun LY, Zhou H. Clinical Impact of Thrombus Aspiration and Interaction With D-Dimer Levels in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Front Cardiovasc Med 2021; 8:706979. [PMID: 34447791 PMCID: PMC8383487 DOI: 10.3389/fcvm.2021.706979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the effect of thrombus aspiration (TA) strategy on the outcomes and its interaction with D-dimer levels in patients with ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) in "real-world" settings. Materials and Methods: This study included 1,295 patients with STEMI who had undergone primary PCI with or without TA between January 2013 and June 2017. Patients were first divided into a TA+PCI group and a PCI-only group, and the baseline characteristics and long-term mortality between the two groups were analyzed. Furthermore, we studied the effect of TA on the clinical outcomes of patients grouped according to quartiles of respective D-dimer levels. The primary outcome was all-cause mortality, and the secondary outcomes were new-onset heart failure (HF), rehospitalization, re-PCI, and stroke. Results: In the original cohort, there were no significant differences in all-cause mortality between the TA+PCI and PCI-only groups (hazard ratio, 0.789; 95% confidence interval, 0.556-1.120; p = 0.185). After a mean follow-up of 2.5 years, the all-cause mortality rates of patients in the TA + PCI and PCI-only groups were 8.5 and 16.2%, respectively. Additionally, differences between the two groups in terms of the risk of HF, re-PCI, rehospitalization, and stroke were non-significant. However, after dividing into quartiles, as the D-dimer levels increased, the all-cause mortality rate in the PCI group gradually increased (4.3 vs. 6.0 vs. 7.0 vs. 14.7%, p < 0.001), while the death rate in the TA+PCI group did not significantly differ (4.6 vs. 5.0 vs. 4.0 vs. 3.75%, p = 0.85). Besides, in the quartile 3 (Q3) and quartile 4 (Q4) groups, the PCI-only group was associated with a higher risk of all-cause mortality than that of the TA+PCI group (Q3: 4.0 vs. 7.0%, p = 0.029; Q4: 3.75 vs. 14.7%, p < 0.001). Moreover, the multivariate logistic regression analysis demonstrated that TA is inversely associated with the primary outcome in the Q4 group [odds ratio (OR), 0.395; 95% CI, 0.164-0.949; p = 0.038]. Conclusions: The findings of our real-world study express that routine manual TA during PCI in STEMI did not improve clinical outcomes overall. However, patients with STEMI with a higher concentration of D-dimer might benefit from the use of TA during primary PCI. Large-scale studies are recommended to confirm the efficacy of TA.
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Affiliation(s)
- Jun-Feng Li
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhi-Wei Lin
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chang-Xi Chen
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shi-Qi Liang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lei-Lei Du
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang Qu
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhan Gao
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu-Heng Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shu-Ting Kong
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jin-Xin Chen
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ling-Yue Sun
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Zhou
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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10
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Gender-Related Difference in D-Dimer Level Predicts In-Hospital Heart Failure after Primary PCI for ST-Segment Elevation Myocardial Infarction. DISEASE MARKERS 2021; 2021:7641138. [PMID: 34422138 PMCID: PMC8373487 DOI: 10.1155/2021/7641138] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/23/2021] [Indexed: 12/27/2022]
Abstract
Aims The prognostic value of plasma D-dimer in patients with coronary artery disease (CAD) remains controversial. The study is aimed at investigating the relationship between plasma D-dimer levels and in-hospital heart failure (HF) in ST-segment elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (pPCI). Methods STEMI patients who underwent pPCI were enrolled in this study. Venous blood samples were collected from patients on admission before pPCI procedure. The study endpoint was the occurrence of in-hospital HF. The participants were divided into two groups according to plasma D-dimer levels and further compared baseline D-dimer levels between male and female. Logistic regression and receiver operating characteristic (ROC) curves were performed to evaluate the relationship of D-dimer and in-hospital HF. Results A total of 778 patients were recruited in the study, of which 539 (69.3%) patients had normal D-dimer levels (≤0.5 mg/L) while 239 (30.7%) had increased D-dimer levels (>0.5 mg/L). The female patients have higher D-dimer levels and higher incident rate of in-hospital HF than that in male patients (p < 0.001). The multivariate logistic regression model revealed that D-dimer was an independent predictor for in-hospital HF in overall population (adjusted odds ratio [OR]: 1.197, 95% CI: 1.003-1.429, and p = 0.046) and female patients (adjusted OR: 1.429, 95% CI: 1.083-1.885, and p = 0.012). Conclusion Increased plasma D-dimer levels were an independent risk factor for incidence of in-hospital HF in STEMI patients who underwent pPCI, especially in female patients, which provides guidance for clinicians in identifying patients at high risk of developing HF and lowering their risk.
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Bai Y, Zheng YY, Tang JN, Yang XM, Guo QQ, Zhang JC, Cheng MD, Song FH, Wang K, Zhang ZL, Liu ZY, Jiang LZ, Fan L, Yue XT, Dai XY, Zheng RJ, Zhang JY. D-Dimer to Fibrinogen Ratio as a Novel Prognostic Marker in Patients After Undergoing Percutaneous Coronary Intervention: A Retrospective Cohort Study. Clin Appl Thromb Hemost 2021; 26:1076029620948586. [PMID: 32842770 PMCID: PMC7453438 DOI: 10.1177/1076029620948586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The role of activation of the coagulation and fibrinolysis system in the pathogenesis and prognosis of cardiovascular diseases (CVDs) has drawn wide attention. Recently, the D-dimer to fibrinogen ratio (DFR) is considered as a useful biomarker for the diagnosis and prognosis of ischemic stroke and pulmonary embolism. However, few studies have explored the relationship between DFR and cardiovascular disease. In our study, patients were divided into 2 groups according to DFR value: the lower group (DFR < 0.52, n = 2123) and the higher group (DFR ≥ 0.52, n = 1073). The primary outcome was all-cause mortality (ACM) and cardiac mortality (CM). The average follow-up time was 37.59 ± 22.24 months. We found that there were significant differences between the 2 groups in term of ACM (2.4% vs 6.6%, P < 0.001) and CM (1.5% vs 4.0%, P < 0.001). Kaplan-Meier analyses showed that elevated DFR had higher incidences of ACM (log rank P < 0.001) and CM (log rank P < 0.001). Multivariate Cox regression analyses showed that DFR was an independent predictor of ACM (HR = 1.743, 95%CI: 1.187-2.559 P = 0.005) and CM (HR = 1.695, 95%CI: 1.033-2.781 P = 0.037). This study indicates that DFR is an independent and novel predictor of long-term ACM and CM in post-PCI patients with CAD.
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Affiliation(s)
- Yan Bai
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Ying-Ying Zheng
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Jun-Nan Tang
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Xu-Ming Yang
- Department of Cardiology, 74623The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Qian-Qian Guo
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Jian-Chao Zhang
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Meng-Die Cheng
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Feng-Hua Song
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Kai Wang
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Zeng-Lei Zhang
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Zhi-Yu Liu
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Li-Zhu Jiang
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Lei Fan
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Xiao-Ting Yue
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Xin-Ya Dai
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Ru-Jie Zheng
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
| | - Jin-Ying Zhang
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, China
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Zhang H, Yao J, Huang Z, Zhao Z, Wang B, Zhao J. Prognostic Value of Baseline d-Dimer Level in Patients With Coronary Artery Disease: A Meta-Analysis. Angiology 2021; 73:18-25. [PMID: 34078130 DOI: 10.1177/00033197211019805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The prognostic significance of d-dimer level in patients with coronary artery disease (CAD) is not fully established. This meta-analysis aimed to examine the association between elevated d-dimer level at baseline and adverse outcomes in patients with CAD. Two independent authors comprehensively searched PubMed and Embase databases from their inception to December 31, 2020. All observational studies reporting the values of baseline d-dimer level in predicting the major adverse cardiovascular events (MACEs) or survival outcomes in patients with CAD were included. The prognostic values were calculated by pooling adjusted RR with 95% CI for the highest versus the lowest d-dimer level. Thirteen studies consisting of 25 600 patients with CAD were identified. Comparison between the highest and lowest d-dimer level showed that the pooled multivariable adjusted RR was 1.69 (95% CI, 1.53-1.86) for all-cause mortality, 2.37 (95% CI, 1.52-3.69) for cardiovascular mortality, and 1.44 (95% CI, 1.19-1.74) for MACEs, respectively. Elevated blood level of d-dimer at baseline was independently associated with higher risk of MACEs, cardiovascular death, and all-cause mortality in patients with CAD. The baseline d-dimer level may have important prognostic value in patients with CAD.
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Affiliation(s)
- Hongliang Zhang
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jing Yao
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhiwei Huang
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhenyan Zhao
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Bincheng Wang
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jie Zhao
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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13
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Chen R, Liu C, Zhou P, Tan Y, Sheng Z, Li J, Zhou J, Chen Y, Song L, Zhao H, Yan H. Prognostic Value of D-dimer in patients with acute coronary syndrome treated by percutaneous coronary intervention: a retrospective cohort study. Thromb J 2021; 19:30. [PMID: 33962644 PMCID: PMC8106213 DOI: 10.1186/s12959-021-00281-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/14/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Associations between D-dimer and outcomes of patients with acute coronary syndromes (ACS) remain controversial. This study aimed to investigate the prognostic value of D-dimer in ACS patients treated by percutaneous coronary intervention (PCI). METHODS In this observational study, 3972 consecutive patients with ACS treated by PCI were retrospectively recruited. The X-tile program was used to determine the optimal D-dimer thresholds for risk stratifications. Cox regression with multiple adjustments was used for outcome analysis. Restricted cubic spline (RCS) analysis was performed to assess the dose-response association between D-dimer and outcomes. The C-index was calculated to evaluate the additional prognostic value of D-dimer when added to clinical risk factors and commonly used clinical risk scores, with internal validations using bootstrapping methods. The primary outcome was all-cause death. RESULTS During a median follow-up of 720 days, 225 deaths occurred. Based on the thresholds generated by X-tile, ACS-PCI patients with median (420-1150 ng/mL, hazard ratio [HR]: 1.58, 95 % confidence interval [CI]: 1.14-2.20, P = 0.007) and high (≥ 1150 ng/mL, HR: 1.98, 95 % CI: 1.36-2.89, P < 0.001) levels of D-dimer showed substantially higher risk of death compared to those with low D-dimer (< 420 ng/mL). RCS analysis depicted a constant relation between D-dimer and various outcomes. The addition of D-dimer levels significantly improved risk predictions for all-cause death when combined with the fully adjusted models (C-index: 0.853 vs. 0.845, P difference = 0.021), the GRACE score (C-index: 0.826 vs. 0.814, P difference = 0.027), and the TIMI score (C-index: 0.804 vs. 0.776, P difference < 0.001). The predicted mortality at the median follow-up (two years) was 1.7 %, 5.2 %, and 10.9 % for patients with low, median, and high D-dimer, respectively, which was well matched with the observed mortality (low D-dimer group: 1.2 %, median D-dimer group: 5.2 %, and high D-dimer group: 12.6 %). CONCLUSIONS For ACS patients treated by PCI, D-dimer level was an independent predictor for adverse outcomes, and provided additional prognostic value when combined with clinical risk factors and risk scores. Risk stratifications based on D-dimer was plausible to differentiate ACS-PCI patients with higher risk of death.
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Affiliation(s)
- Runzhen Chen
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
- Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, 167 Beilishi Rd, Xicheng District, 100037, Beijing, China
| | - Chen Liu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, 167 Beilishi Rd, Xicheng District, 100037, Beijing, China
| | - Peng Zhou
- Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, 167 Beilishi Rd, Xicheng District, 100037, Beijing, China
| | - Yu Tan
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | | | - Jiannan Li
- Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, 167 Beilishi Rd, Xicheng District, 100037, Beijing, China
| | - Jinying Zhou
- Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, 167 Beilishi Rd, Xicheng District, 100037, Beijing, China
| | - Yi Chen
- Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, 167 Beilishi Rd, Xicheng District, 100037, Beijing, China
| | - Li Song
- Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, 167 Beilishi Rd, Xicheng District, 100037, Beijing, China
| | - Hanjun Zhao
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
- Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, 167 Beilishi Rd, Xicheng District, 100037, Beijing, China
| | - Hongbing Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.
- Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, 167 Beilishi Rd, Xicheng District, 100037, Beijing, China.
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Li J, Zhao Z, Jiang H, Jiang M, Yu G, Li X. Predictive value of elevated alanine aminotransferase for in-hospital mortality in patients with acute myocardial infarction. BMC Cardiovasc Disord 2021; 21:82. [PMID: 33563221 PMCID: PMC7874605 DOI: 10.1186/s12872-021-01903-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022] Open
Abstract
Background and aims Liver enzymes, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), are markers of hepatic dysfunction and fatty liver disease. Although ALT and AST have been suggested as risk factors for cardiovascular disease, their role as predictors of mortality after acute myocardial infarction (AMI) has not been established. The objective of this study was to investigate the predictive value of ALT and AST for mortality in patients with AMI. Methods We analyzed records of 712 patients with AMI and no known liver disease treated at the Department of Cardiovascular Center in the First Hospital of Jilin University. The primary outcome was all-cause in-hospital mortality. Relationships between primary outcome and various risk factors, including serum transaminase levels, were assessed using multivariate logistic regression analysis. Results Age (P < 0.001), hypertension (P = 0.034), prior myocardial infarction (P < 0.001), AST (P < 0.001), ALT (P < 0.001), creatinine (P = 0.007), blood urea nitrogen (P = 0.006), and troponin I (P < 0.001) differed significantly between ST-segment elevation myocardial infarction (STEMI) and non-STEMI. The following factors were associated with an increased risk of in-hospital all-cause mortality in patients with AMI: ALT ≥ 2ULN (adjusted odds ratio [AOR] 2.240 [95% confidence interval (CI), 1.331–3.771]; P = 0.002); age ≥ 65 year (AOR 4.320 [95% CI 2.687–6.947]; P < 0.001); increased fasting plasma glucose (FPG) (AOR 2.319 [95% CI 1.564–3.438]; P < 0.001); elevated D-dimer (AOR 2.117 [95% CI 1.407–3.184]; P < 0.001); elevated fibrinogen (AOR 1.601 [95% CI 1.077–2.380]; P = 0.20); and reduced estimated glomerular filtration rate (eGFR) (AOR 2.279 [95% CI 1.519–3.419]; P < 0.001). Conclusions Our findings demonstrated that elevated ALT was independently associated with increased in-hospital all-cause mortality in patients with AMI. Other risk factors were increased age, FPG, D-dimer, and fibrinogen and decreased eGFR.
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Affiliation(s)
- Jian Li
- Department of Hepatology, The First Hospital of Jilin University, No. 71, Xinmin Street, Changchun, Jilin, China
| | - Zhuo Zhao
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Hui Jiang
- Medical Oncology Department, Jilin Cancer Hospital, Changchun, Jilin, China
| | - Minjie Jiang
- Department of Hepatology, The First Hospital of Jilin University, No. 71, Xinmin Street, Changchun, Jilin, China
| | - Ge Yu
- Department of Hepatology, The First Hospital of Jilin University, No. 71, Xinmin Street, Changchun, Jilin, China
| | - Xu Li
- Department of Hepatology, The First Hospital of Jilin University, No. 71, Xinmin Street, Changchun, Jilin, China.
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15
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Optimization of GRACE Risk Stratification by N-Terminal Pro-B-type Natriuretic Peptide Combined With D-Dimer in Patients With Non-ST-Elevation Myocardial Infarction. Am J Cardiol 2021; 140:13-19. [PMID: 33159905 DOI: 10.1016/j.amjcard.2020.10.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 11/22/2022]
Abstract
We aimed to explore the utility of multiple biomarkers with GRACE risk stratification for non-ST-elevation myocardial infarction (NSTEMI). A total of 1,357 patients diagnosed with NSTEMI were enrolled in this study at multiple medical centers in Tianjin, China. The outcomes were 1-year all-cause death and major adverse cardiac events (MACE: all-cause death, hospital admission for unstable angina, hospital admission for heart failure, nonfatal recurrent myocardial infarction, and stroke). C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to verify that the biomarkers improve the predictive accuracy of the GRACE score. A total of 57 participants died, while 211 participants experienced 231 MACEs during follow-up (mean: 339 days). For all-cause death, the combination of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and D-dimer improved the predictive accuracy of GRACE the most, with C-index, IDI, and NRI values of 0.88, 0.085, and 1.223, respectively. For MACE, trigeminal combination of NT-proBNP, fibrinogen, and D-dimer resulted in C-index, IDI, and NRI values of 0.80, 0.079, and 0.647, respectively. As a result, NT-proBNP, D-dimer, fibrinogen, and GRACE comprise a new scoring system for assessing 1-year clinical events. Kaplan-Meier analysis revealed a significant increase in 1-year mortality (score ≥3.85 vs <3.85, p < 0.0001) and 1-year MACE (score ≥1.72 vs <1.72, p < 0.0001) between different score groups. In conclusion, the combination of NT-proBNP and D-dimer added prognostic value to GRACE for all-cause death. Combining NT-proBNP, fibrinogen, and D-dimer increased the prognostic value of GRACE for MACE. This newly developed scoring system is strongly correlated with all-cause mortality and MACE, and can be easily utilized in clinical practice.
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16
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Lei M, Liu C, Luo Z, Xu Z, Jiang Y, Lin J, Wang C, Jiang D. Diagnostic management of inpatients with a positive D-dimer test: developing a new clinical decision-making rule for pulmonary embolism. Pulm Circ 2021; 11:2045894020943378. [PMID: 33456753 PMCID: PMC7797584 DOI: 10.1177/2045894020943378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/26/2020] [Indexed: 11/16/2022] Open
Abstract
Background A positive D-dimer test has high sensitivity but relatively poor specificity
for the diagnosis of pulmonary embolism, causing difficulty for clinicians
unskilled in pulmonary embolism diagnosis in determining whether a patient
with a positive D-dimer test needs to undergo computed tomographic pulmonary
angiography. Objectives We sought to develop a new clinical decision-making rule based on a positive
D-dimer result to predict the probability of pulmonary embolism and to guide
clinicians in making decisions regarding the need for computed tomographic
pulmonary angiography. Methods We conducted a prospective, multicenter study in three hospitals in China. A
total of 3014 inpatients with positive D-dimer results were included. In the
derivation group, we built a multivariate logistic regression model and
deduced a regression equation from which our score was derived. Finally, we
validated the score in an independent cohort. Results Our score included nine variables (points): chest pain (1.4), chest tightness
(2.3), shortness of breath (3.6), hemoptysis (3.4), heart rate ≥100
beats/min (3.6), blood gas analysis (2.9), electrocardiogram presenting a
typical S1Q3T3 pattern (4.1), electrocardiogram findings (2.4), and
ultrasonic cardiogram findings (3.7). The sensitivities and specificities
were 100% and 86.94%, respectively, in the derivation group and 100% and
90.82%, respectively, in the validation group. Additionally, the observed
and predicted proportions of patients who underwent computed tomographic
pulmonary angiography were 16.82% and 10.76%, respectively, in the
derivation group and 18.72% and 11.40%, respectively, in the validation
group. Conclusions The new score can categorize inpatients with a positive D-dimer test as
pulmonary embolism-likely or pulmonary embolism-unlikely, thus reducing
unnecessary computed tomographic pulmonary angiography examinations.
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Affiliation(s)
- Min Lei
- Department of Geriatric Medicine, The Fuling Central Hospital of Chongqing, Chongqing, China
| | - Chang Liu
- Department of Respiratory medicine, The Second Clinical Hospital of Chongqing Medical University, Chongqing, China
| | - Zhuang Luo
- Department of Respiratory Medicine, The First Clinical Hospital of Kunming Medical College, Kunming, China
| | - Zhibo Xu
- Department of Respiratory Medicine, The Second People's Hospital of Chengdu City, Chengdu, China
| | - Youfan Jiang
- Department of Respiratory medicine, The Second Clinical Hospital of Chongqing Medical University, Chongqing, China
| | - Jiachen Lin
- Department of Respiratory Medicine, The Second People's Hospital of Chengdu City, Chengdu, China
| | - Chu Wang
- Department of Respiratory Medicine, The First Clinical Hospital of Kunming Medical College, Kunming, China
| | - Depeng Jiang
- Department of Respiratory medicine, The Second Clinical Hospital of Chongqing Medical University, Chongqing, China
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Carvalho HC. D-dimers in the identification of vascular risk: A good tool or just another one? Rev Port Cardiol 2020; 39:695-696. [PMID: 33309129 DOI: 10.1016/j.repc.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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18
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Carvalho HC. D-dimers in the identification of vascular risk: A good tool or just another one? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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19
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Krychtiuk KA, Speidl WS, Giannitsis E, Gigante B, Gorog DA, Jaffe AS, Mair J, Möckel M, Mueller C, Storey RF, Vilahur G, Wojta J, Huber K, Halvorsen S, Geisler T, Morais J, Lindahl B, Thygesen K. Biomarkers of coagulation and fibrinolysis in acute myocardial infarction: a joint position paper of the Association for Acute CardioVascular Care and the European Society of Cardiology Working Group on Thrombosis. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 10:343-355. [PMID: 33620437 DOI: 10.1093/ehjacc/zuaa025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
The formation of a thrombus in an epicardial artery may result in an acute myocardial infarction (AMI). Despite major advances in acute treatment using network approaches to allocate patients to timely reperfusion and optimal antithrombotic treatment, patients remain at high risk for thrombotic complications. Ongoing activation of the coagulation system as well as thrombin-mediated platelet activation may both play a crucial role in this context. Whether measurement of circulating biomarkers of coagulation and fibrinolysis could be useful for risk stratification in secondary prevention is currently not fully understood. In addition, measurement of such biomarkers could be helpful to identify thrombus formation as the leading mechanism for AMI. The introduction of biomarkers of myocardial injury such as high-sensitivity cardiac troponins made rule-out of AMI even more precise. However, elevated markers of myocardial injury cannot provide proof of a type 1 AMI, let alone thrombus formation. The combined measurement of markers of myocardial injury with biomarkers reflecting ongoing thrombus formation might be helpful for the fast and correct diagnosis of an atherothrombotic type 1 AMI. This position paper gives an overview of the current knowledge and possible role of biomarkers of coagulation and fibrinolysis for the diagnosis of AMI, risk stratification, and individualized treatment strategies in patients with AMI.
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Affiliation(s)
- Konstantin A Krychtiuk
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Walter S Speidl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Evangelos Giannitsis
- Department of Internal Medicine III, Cardiology, Angiology, Pulmonology, Medical University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Bruna Gigante
- Unit of Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden.,Department of Clinical Science, Danderyds Hospital, Entrévägen 2, 182 57 Danderyd, Sweden
| | - Diana A Gorog
- Department of Medicine, National Heart & Lung Institute, Imperial College, Guy Scadding Building, Dovehouse St, Chelsea, London SW3 6LY, UK.,Postgraduate Medical School, University of Hertfordshire, Hatfield, UK
| | - Allan S Jaffe
- Department of Cardiology, Mayo Clinic, 1216 2nd St SW Rochester, MN 55902, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, 1216 2nd St SW Rochester, MN 55902, USA
| | - Johannes Mair
- Department of Internal Medicine III - Cardiology and Angiology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Martin Möckel
- Division of Emergency and Acute Medicine and Chest Pain Units, Charite - Universitätsmedizin Berlin, Campus Mitte and Virchow, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Robert F Storey
- Cardiovascular Research Unit, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Beech Hill Rd, Sheffield S10 2RX, UK
| | - Gemma Vilahur
- Cardiovascular Program ICCC - Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Calle de Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Johann Wojta
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Kurt Huber
- Ludwig Boltzmann Institute for Cardiovascular Research, Waehringer Guertel 18-20, 1090 Vienna, Austria.,3rd Medical Department of Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstraße 37, 1160 Vienna, Austria
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Tobias Geisler
- University Hospital Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Joao Morais
- Division of Cardiology, Santo Andre's Hospital, R. de Santo André, 2410-197 Leiria, Portugal
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala Clinical Research Center, Dag Hammarskjölds Väg 38, 751 85 Uppsala University, Uppsala, Sweden
| | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus N, Denmark
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20
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Zhang X, Wang S, Liu J, Wang Y, Cai H, Wang D, Fang S, Yu B. D-dimer and the incidence of heart failure and mortality after acute myocardial infarction. Heart 2020; 107:237-244. [PMID: 32788198 DOI: 10.1136/heartjnl-2020-316880] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE D-dimer might serve as a marker of thrombogenesis and a hypercoagulable state following plaque rupture. Few studies explore the association between baseline D-dimer levels and the incidence of heart failure (HF), all-cause mortality in an acute myocardial infarction (AMI) population. We aimed to explore this association. METHODS We enrolled 4504 consecutive patients with AMI with complete data in a prospective cohort study and explored the association of plasma D-dimer levels on admission and the incidence of HF, all-cause mortality. RESULTS Over a median follow-up of 1 year, 1112 (24.7%) patients developed in-hospital HF, 542 (16.7%) patients developed HF after hospitalisation and 233 (7.1%) patients died. After full adjustments for other relevant clinical covariates, patients with D-dimer values in quartile 3 (Q3) had 1.51 times (95% CI 1.12 to 2.04) and in Q4 had 1.49 times (95% CI 1.09 to 2.04) as high as the risk of HF after hospitalisation compared with patients in Q1. Patients with D-dimer values in Q4 had more than a twofold (HR 2.34; 95% CI 1.33 to 4.13) increased risk of death compared with patients in Q1 (p<0.001). But there was no association between D-dimer levels and in-hospital HF in the adjusted models. CONCLUSIONS D-dimer was found to be associated with the incidence of HF after hospitalisation and all-cause mortality in patients with AMI.
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Affiliation(s)
- Xiaoyuan Zhang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Shanjie Wang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Jinxin Liu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Yini Wang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hengxuan Cai
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Shaohong Fang
- Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
| | - Bo Yu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China .,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
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21
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Zhou Q, Xue Y, Shen J, Zhou W, Wen Y, Luo S. Predictive values of D-dimer for the long-term prognosis of acute ST-segment elevation infarction: A retrospective study in southwestern China. Medicine (Baltimore) 2020; 99:e19724. [PMID: 32311962 PMCID: PMC7220445 DOI: 10.1097/md.0000000000019724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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.
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22
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Gong X, Lei X, Huang Z, Song Y, Wang Q, Qian J, Ge J. D-Dimer Level Predicts Angiographic No-Reflow Phenomenon After Percutaneous Coronary Intervention Within 2-7 Days of Symptom Onset in Patients with ST-Segment Elevation Myocardial Infarction. J Cardiovasc Transl Res 2020; 14:728-734. [PMID: 32212039 DOI: 10.1007/s12265-020-09991-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
It remains uncertain whether plasma D-dimer level can predict no-reflow in patients with STEMI who had pPCI after 48 h of symptom onset. This study retrospectively enrolled 229 consecutive patients who had pPCI for acute STEMI within 2-7 days of symptom onset between January 2008 and December 2018. Patients were divided into no-reflow group (TIMI flow grade 0-2) and reflow group (TIMI flow grade 3). Predictors of no-reflow were assessed by univariate and multivariate binary logistic regression analyses. Plasma D-dimer level can independently predict no-reflow in patients with STEMI who had pPCI within 2-7 days of symptom onset (OR 2.52 per 1 mg/L increase, 95% CI 1.16-5.47, p = 0.019). This finding indicated that pPCI may be safe and feasible for STEMI patients within 2-7 days of symptom onset with low D-dimer level. Graphical Abstract Plasma D-dimer level can independently predict no-reflow in patients with STEMI who had pPCI within 2-7 days of symptom onset. pPCI may be safe and feasible for STEMI patients within 2-7 days of symptom onset with low D-dimer level.
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Affiliation(s)
- Xue Gong
- Department of Cardiology, DeltaHealth Hospital, Shanghai, China.,Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Xiaoting Lei
- Department of Cardiology, No. 1 Hospital of Tianshui City, Tianshui, Gansu Province, China
| | - Zheyong Huang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Yanan Song
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Qibing Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Juying Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Zhao X, Li J, Tang X, Jiang L, Chen J, Qiao S, Yang Y, Gao R, Xu B, Yuan J. D-dimer as a thrombus biomarker for predicting 2-year mortality after percutaneous coronary intervention. Ther Adv Chronic Dis 2020; 11:2040622320904302. [PMID: 32206246 PMCID: PMC7076575 DOI: 10.1177/2040622320904302] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/09/2020] [Indexed: 01/13/2023] Open
Abstract
Background: D-dimer has predictive value for mortality in some diseases. This study aimed to evaluate the correlation between D-dimer and mortality in patients undergoing percutaneous coronary intervention (PCI). Methods: We examined 10,724 consecutive patients who underwent PCI between January 2013 and December 2013. The primary endpoint was all-cause mortality, and the secondary endpoint was cardiac mortality. Patients were divided according to the median D-dimer level of 0.28 μg/ml. Multivariable model were including age, sex, and risk factors after stepwise selection. Results: After a 2-year follow up, 8565 patients with D-dimer data were analyzed. There were 116 (1.35%) all-cause deaths and 64 (0.75%) cardiac deaths. D-dimer levels were significantly higher in the all-cause mortality group [0.42 (0.29, 0.68) μg/ml] and cardiac mortality group [0.48 (0.30, 0.81) μg/ml] than in the survival group [0.28 (0.20, 0.41) μg/ml] (both p < 0.001). Multivariate-adjusted Cox hazard analysis showed that high D-dimer levels (⩾0.28 μg/ml) were significantly associated with all-cause mortality in the total population [hazard ratio (HR): 2.35, 95% confidence interval (CI): 1.44–3.84, p = 0.001], acute coronary syndrome (ACS) subgroup (HR: 1.91, 95% CI: 1.08–3.38, p = 0.027), and stable coronary artery disease (SCAD) subgroup (HR: 3.82, 95% CI: 1.45–10.10, p = 0.007). High D-dimer levels were significantly associated with cardiac mortality in the total population (HR: 3.44, 95% CI: 1.61–7.36, p = 0.001) and the ACS subgroup (HR: 3.33, 95% CI: 1.38–8.03, p = 0.007), but not in the SCAD subgroup (HR: 3.68, 95% CI: 0.80–16.91, p = 0.094). Conclusions: D-dimer levels are independently associated with 2-year all-cause mortality and cardiac mortality in patients undergoing PCI.
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Affiliation(s)
- Xueyan Zhao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianxin Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofang Tang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Jiang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jue Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
| | - Jinqing Yuan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
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Lin KY, Chen HC, Jiang H, Wang SY, Chen HM, Wu ZY, Jiang F, Guo YS, Zhu PL. Predictive value of admission D-dimer for contrast-induced acute kidney injury and poor outcomes after primary percutaneous coronary intervention. BMC Nephrol 2020; 21:90. [PMID: 32156263 PMCID: PMC7063708 DOI: 10.1186/s12882-020-01743-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND DD was found to be associated with acute myocardial infarction (AMI) and renal insufficiency. However, it is uncertain whether DD is an independent risk factor of CI-AKI in patients undergoing pPCI. METHODS We prospectively enrolled 550 consecutive patients with STEMI undergoing pPCI between January 2012 and December 2016. The predictive value of admission DD for CI-AKI was assessed by receiver operating characteristic (ROC) and multivariable logistic regression analysis. CI-AKI was defined as an absolute serum creatinine increase ≥0.3 mg/dl or a relative increase in serum creatinine ≥50% within 48 h of contrast medium exposure. RESULTS Overall, the incidence of CI-AKI was 13.1%. The ROC analysis showed that the cutoff point of DD was 0.69 μg/ml for predicting CI-AKI with a sensitivity of 77.8% and a specificity of 57.3%. The predictive value of DD was similar to the Mehran score for CI-AKI (AUCDD = 0.729 vs AUCMehran = 0.722; p = 0.8298). Multivariate logistic regression analysis indicated that DD > 0.69 μg/ml was an independent predictor of CI-AKI (odds ratio [OR] = 3.37,95% CI:1.80-6.33, p < 0.0001). Furthermore, DD > 0.69 μg/ml was associated with an increased risk of long-term mortality during a mean follow-up period of 16 months (hazard ratio = 3.41, 95%CI:1.4-8.03, p = 0.005). CONCLUSION Admission DD > 0.69 μg/ml was a significant and independent predictor of CI-AKI and long-term mortality in patients undergoing pPCI.
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Affiliation(s)
- Kai-Yang Lin
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Han-Chuan Chen
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Hui Jiang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Sun-Ying Wang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Hong-Mei Chen
- Department of Nursing, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Zhi-Yong Wu
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Feng Jiang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Yan-Song Guo
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China.
| | - Peng-Li Zhu
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China.
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Huang D, Gao W, Wu R, Zhong X, Qian J, Ge J. D-dimer level predicts in-hospital adverse outcomes after primary PCI for ST-segment elevation myocardial infarction. Int J Cardiol 2020; 305:1-4. [PMID: 32057475 DOI: 10.1016/j.ijcard.2020.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 02/06/2023]
Abstract
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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Affiliation(s)
- Dong Huang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Wei Gao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Runda Wu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Xin Zhong
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
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Yu T, Jiao Y, Song J, He D, Wu J, Sun Z, Sun Z. Hospital mortality in acute coronary syndrome: adjustment of GRACE score by D-dimer enables a more accurate prediction in a prospective cohort study. BMC Cardiovasc Disord 2019; 19:252. [PMID: 31707974 PMCID: PMC6842504 DOI: 10.1186/s12872-019-1239-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 10/25/2019] [Indexed: 11/30/2022] Open
Abstract
Backgroud To assess the value of D-dimer and its combination with The Global Registry of Acute Coronary Events (GRACE) score in predicting in-hospital mortality in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Methods In 5923 ACS patients undergoing PCI, the role of D-dimer and the added value of D-dimer to GRACE score for predicting in-hospital mortality were tested. Results After multivariable adjustment, D-dimer could significantly predict in-hospital mortality. Also, it could significantly improve the prognostic performance of GRACE score (C-statistic: z = 2.269, p = 0.023; IDI: 0.016, p = 0.032; NRI: 0.291, p = 0.035). Conclusion In patients with ACS undergoing PCI, D-dimer was an independent predictor of in-hospital death. It could also improve the prognostic performance of GRACE score.
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Affiliation(s)
- Tongtong Yu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yundi Jiao
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Jia Song
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Dongxu He
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Jiake Wu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
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Dong Y, Hou H, Chen A, Ma W, Yin M, Meng F, Hu C, Wang H, Cai J. Generation of a Monoclonal Antibody against D-Dimer Using HTS-Based LiCA. SLAS DISCOVERY 2019; 25:310-319. [PMID: 31560248 DOI: 10.1177/2472555219878407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
D-dimer is an essential diagnostic index of thrombotic diseases. Since the existing anti-D-dimer antibodies vary in quality and specificity, a search for alternative anti-D-dimer antibodies is required. The present study aimed to screen a novel monoclonal antibody (mAb) against D-dimer using a light-initiated chemiluminescence assay (LiCA). In this work, mice were immunized with antigen prepared from human plasma by enzyme hydrolysis. After screening, a novel mAb, DD 2G11, was obtained. The results of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and Western blot analysis indicated that DD 2G11 could be used as a standard marker for D-dimer. The isotype of DD 2G11 was IgG1, the Ka value was 0.646 nM-1, and the Kd value was 50 nM, indicating that the binding affinity to D-dimer was very high. Furthermore, no cross-reactivity between DD 2G11 and other fibrinogen degradation products (FgDPs) was found. Finally, the correlation between DD 2G11 and the reference antibody (commercial antibody) was investigated by analyzing 56 clinical samples using a latex-enhanced turbidimetric immunoassay (LTIA). The R2 value of the linear regression was 0.94538, indicating that DD 2G11 met clinical requirements. In conclusion, the present study provides a more expeditious protocol to screen mAbs and provides a clinically usable mAb against D-dimer.
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Affiliation(s)
- Yuan Dong
- Academy of Laboratory, Jilin Medical University, Jilin, PR China
| | - Hanjin Hou
- Academy of Laboratory, Jilin Medical University, Jilin, PR China
| | - An Chen
- Department of Clinical Biochemistry, Faculty of Pharmacy and Laboratory Medicine, Army Medical University, Chongqing, PR China
| | - Wei Ma
- Academy of Laboratory, Jilin Medical University, Jilin, PR China
| | - Moli Yin
- Academy of Laboratory, Jilin Medical University, Jilin, PR China
| | - Fanwei Meng
- Academy of Laboratory, Jilin Medical University, Jilin, PR China
| | - Chuanmin Hu
- Department of Clinical Biochemistry, Faculty of Pharmacy and Laboratory Medicine, Army Medical University, Chongqing, PR China.,Jilin Collaborative Innovation Center for Antibody Engineering, Jilin Medical University, Jilin, PR China
| | - Huiyan Wang
- Jilin Collaborative Innovation Center for Antibody Engineering, Jilin Medical University, Jilin, PR China
| | - Jianhui Cai
- Jilin Collaborative Innovation Center for Antibody Engineering, Jilin Medical University, Jilin, PR China
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AlKhalfan F, Kerneis M, Nafee T, Yee MK, Chi G, Plotnikov A, Braunwald E, Gibson CM. D-Dimer Levels and Effect of Rivaroxaban on Those Levels and Outcomes in Patients With Acute Coronary Syndrome (An ATLAS ACS-TIMI 46 Trial Substudy). Am J Cardiol 2018; 122:1459-1464. [PMID: 30217378 DOI: 10.1016/j.amjcard.2018.07.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 11/19/2022]
Abstract
D-dimer has been used as both a diagnostic and prognostic biomarker in the assessment of patients with venous thromboembolism, but its prognostic value in the setting of arterial acute coronary syndromes (ACS) and the ability of pharmacotherapy to reduce D-dimer in ACS is less well characterized. It was hypothesized that elevated baseline D-dimer would be associated with poor clinical outcomes in ACS, and that Factor Xa inhibition with Rivaroxaban would reduce D-dimer acutely and chronically. The ATLAS ACS TIMI-46 trial assessed the safety and efficacy of rivaroxaban compared with placebo in ACS patients. A subset of subjects had a D-dimer measured at baseline (n = 1,834, 52.5%). A univariate and multivariable logistic regression assessed the relation between baseline D-dimer and a composite end point of cardiovascular death, myocardial infarction, or stroke through 6 months. The Wilcoxon rank sum test was used to compare change in D-dimer level between the treatment groups from baseline. Baseline D-dimer was associated with the composite efficacy outcome in a univariate logistic regression (odds ratio 1.15, 95% confidence interval 1.03 to 1.29, p = 0.015) and a multivariable logistic regression (odds ratio 1.13, 95% confidence interval 1.00 to 1.28, p = 0.048). Rivaroxaban administration lowered D-dimer levels compared wth placebo after administration of the first dose of study drug (p = 0.026), at day 30 (p < 0.001) and day 180 (p < 0.001). In conclusion, elevated baseline D-dimer was associated with an increased risk of the composite outcome within 6 months of the ACS event and administration of the Factor Xa inhibitor rivaroxaban was associated with lower D-dimer levels compared with placebo after the first dose, at day 30 and day 180.
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Affiliation(s)
- Fahad AlKhalfan
- Division of Cardiovascular Medicine, The PERFUSE Study Group, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mathieu Kerneis
- Division of Cardiovascular Medicine, The PERFUSE Study Group, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Tarek Nafee
- Division of Cardiovascular Medicine, The PERFUSE Study Group, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Megan K Yee
- Division of Cardiovascular Medicine, The PERFUSE Study Group, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Gerald Chi
- Division of Cardiovascular Medicine, The PERFUSE Study Group, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Alexei Plotnikov
- Johnson & Johnson Pharmaceutical Research and Development, Raritan, New Jersey
| | - Eugene Braunwald
- Division of Cardiovascular Medicine, TIMI Study Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - C Michael Gibson
- Division of Cardiovascular Medicine, The PERFUSE Study Group, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Rodrigues VC, Moraes ML, Soares JC, Soares AC, Sanfelice R, Deffune E, Oliveira ON. Immunosensors Made with Layer-by-Layer Films on Chitosan/Gold Nanoparticle Matrices to Detect D-Dimer as Biomarker for Venous Thromboembolism. BULLETIN OF THE CHEMICAL SOCIETY OF JAPAN 2018. [DOI: 10.1246/bcsj.20180019] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Valquiria C. Rodrigues
- São Carlos Institute of Physics, University of São Paulo, 13560-970 São Carlos-SP, Brazil
| | - Marli L. Moraes
- Federal University of São Paulo, Unifesp, Campus São José dos Campos, SP, Brazil
| | - Juliana C. Soares
- São Carlos Institute of Physics, University of São Paulo, 13560-970 São Carlos-SP, Brazil
| | - Andrey C. Soares
- São Carlos Institute of Physics, University of São Paulo, 13560-970 São Carlos-SP, Brazil
| | - Rafaela Sanfelice
- Department of Chemical Engineering, Federal University of the Triângulo Mineiro, Uberaba-MG, Brazil
| | - Elenice Deffune
- Department of Urology, Medical School, UNESP, Botucatu-SP, Brazil
| | - Osvaldo N. Oliveira
- São Carlos Institute of Physics, University of São Paulo, 13560-970 São Carlos-SP, Brazil
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Hansen CH, Ritschel V, Andersen GØ, Halvorsen S, Eritsland J, Arnesen H, Seljeflot I. Markers of Thrombin Generation Are Associated With Long-Term Clinical Outcome in Patients With ST-Segment Elevation Myocardial Infarction. Clin Appl Thromb Hemost 2018; 24:1088-1094. [PMID: 29695176 PMCID: PMC6714743 DOI: 10.1177/1076029618764847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Hypercoagulability in ST-segment elevation myocardial infarction (STEMI) as related to long-term clinical outcome is not clarified. We aimed to investigate whether prothrombin fragment 1+2 (F1+2), d-dimer, and endogenous thrombin potential (ETP) measured in the acute phase of STEMI were associated with outcome. Blood samples were drawn median 24 hours after symptom onset in 987 patients with STEMI. Median follow-up time was 4.6 years. Primary outcome was a composite of all-cause mortality, reinfarction, stroke, unscheduled revascularization, or rehospitalization for heart failure; secondary outcome was total mortality. The number of combined end points/total mortality was 195/79. Higher levels of d-dimer and F1+2 were observed with both end points (all P < .005), whereas ETP was significantly lower (P < .01). Dichotomized at medians, increased risk was observed for levels above median for F1+2 and d-dimer (combined end point P = .020 and P = .010 and total mortality P < .001, both), while an inverse pattern was observed for ETP (P < .02, both). Adjusting for covariates, d-dimer was still associated with reduced risk of total mortality (P = .034) and receiver operating characteristic curve analyses showed area under the curve of 0.700 (95% confidence interval, 0.640-0.758). The hypercoagulable state in acute STEMI seems to be of importance for clinical outcome.
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Affiliation(s)
- Charlotte Holst Hansen
- 1 Center for Clinical Heart Research, Oslo University Hospital, Ullevål, Oslo, Norway.,2 Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Vibeke Ritschel
- 1 Center for Clinical Heart Research, Oslo University Hospital, Ullevål, Oslo, Norway.,2 Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway.,3 Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Geir Øystein Andersen
- 1 Center for Clinical Heart Research, Oslo University Hospital, Ullevål, Oslo, Norway.,2 Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Sigrun Halvorsen
- 2 Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway.,3 Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jan Eritsland
- 2 Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Harald Arnesen
- 1 Center for Clinical Heart Research, Oslo University Hospital, Ullevål, Oslo, Norway.,3 Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingebjørg Seljeflot
- 1 Center for Clinical Heart Research, Oslo University Hospital, Ullevål, Oslo, Norway.,2 Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway.,3 Faculty of Medicine, University of Oslo, Oslo, Norway
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Sullivan K, Wellsted D, Christopoulos C, Farag M, Gorog DA. Impaired thrombolytic status predicts adverse cardiac events in patients undergoing primary percutaneous coronary intervention. Thromb Haemost 2017; 117:457-470. [DOI: 10.1160/th16-09-0712] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/16/2016] [Indexed: 11/05/2022]
Abstract
SummaryAntithrombotic medications reduce thrombosis but increase bleeding. Identification of ST-elevation myocardial infarction (STEMI) patients at risk of recurrent thrombosis could allow targeted treatment with potent antithrombotic medications, with less potent agents in others, to reduce bleeding. Conventional platelet function tests assess platelet reactivity only, yet there is increasing evidence that endogenous thrombolytic potential determines outcome following thrombus initiation. We investigated whether assessing both platelet reactivity and endogenous thrombolysis, could identify STEMI patients at high-risk of recurrent thrombotic events. Thrombotic status was assessed in STEMI patients, before and after primary percutaneous coronary intervention (PPCI), at discharge and at 30 days; with 12 months’ followup. The time to form an occlusive thrombus under high shear (occlusion time, OT), and time to restore flow by endogenous thrombolysis (lysis time, LT) was measured using the point-of-care Global Thrombosis Test (GTT) in the cardiac catheterisation laboratory. Impaired endogenous thrombolysis (prolonged LT ≥ 3000 s), seen in 13 % patients pre-PPCI, was related to major adverse cardiac events, MACE (HR: 3.31, 95 %CI: 1.02–10.78, p = 0.045), driven by cardiovascular death (HR: 4.17, 95 %CI: 0.99–17.51, p = 0.05). Enhanced (rapid) endogenous thrombolysis (LT < 1000 s) was associated with spontaneous reperfusion, ST-segment resolution and Thrombolysis In Myocardial Infarction 3 flow pre-PPCI. Baseline OT was shorter in those with MACE (especially recurrent myocardial infarction and stroke) than those without (253 ± 150 s vs 354 ± 134 s, p=0.017). Endogenous thrombolysis, when impaired, is associated with increased cardiovascular risk, and when enhanced, with spontaneous reperfusion. Endogenous thrombolysis may be a novel target for pharmacological intervention, and allow targeting of potent antithrombotic medications to high-risk patients.
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Monoclonal antibodies with equal specificity to D-dimer and high-molecular-weight fibrin degradation products. Blood Coagul Fibrinolysis 2017; 27:542-50. [PMID: 26656897 PMCID: PMC4935535 DOI: 10.1097/mbc.0000000000000453] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Fibrin degradation results in the formation of fibrin degradation products (FDPs) of different molecular weights, which include D-dimer. Commercial D-dimer assays recognize multiple forms of FDP with different specificity. As a result, the absence of an international D-dimer standard and the marked discrepancy in the D-dimer values in the same samples measured by assays from different manufacturers have become the primary problems that clinicians face in the D-dimer determination. We consider that an assay with equal specificity to all FDP forms regardless of their molecular weights could help to solve these problems. We aimed to produce mAbs that could equally recognize high-molecular-weight FDP (HMW FDP) and D-dimer. mAbs against D-dimer were produced. The HMW FDP/D-dimer ratios in plasma samples were analyzed following protein separation by gel filtration using the developed fluoroimmunoassay. A sandwich immunoassay with equal specificity to HMW FDP and D-dimer was developed and applied to determine HMW FDP/D-dimer ratios in patients with different diseases. Although the HMW FDP levels prevailed in thrombotic patients, the FDP and D-dimer levels were comparable in septic patients. Meanwhile, the D-dimer levels often exceeded the HMW FDP levels in patients who had undergone surgery. The 'D-dimer' levels that were detected by different assays also varied greatly depending on the assay specificities to FDP and D-dimer. Our findings show that the introduction of assays with equal specificities to FDP and D-dimer in clinical practice is a possible way of standardizing D-dimer measurements.
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Choi S, Jang WJ, Song YB, Lima JAC, Guallar E, Choe YH, Hwang JK, Kim EK, Yang JH, Hahn JY, Choi SH, Lee SC, Lee SH, Gwon HC. D-Dimer Levels Predict Myocardial Injury in ST-Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study. PLoS One 2016; 11:e0160955. [PMID: 27513758 PMCID: PMC4981325 DOI: 10.1371/journal.pone.0160955] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/27/2016] [Indexed: 12/11/2022] Open
Abstract
Objectives Elevated D-dimer levels on admission predict prognosis in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), but the association of D-dimer levels with structural markers of myocardial injury in these patients is unknown. Methods We performed cardiac magnetic resonance (CMR) imaging in 208 patients treated with primary PCI for STEMI. CMR was performed a median of 3 days after the index procedure. Of the 208 patients studied, 75 patients had D-dimer levels above the normal range on admission (>0.5 μg/mL; high D-dimer group) while 133 had normal levels (≤0.5 μg/mL; low D-dimer group). The primary outcome was myocardial infarct size assessed by CMR. Secondary outcomes included area at risk (AAR), microvascular obstruction (MVO) area, and myocardial salvage index (MSI). Results In CMR analysis, myocardial infarct size was larger in the high D-dimer group than in the low D-dimer group (22.3% [16.2–30.5] versus 18.8% [10.7–26.7]; p = 0.02). Compared to the low D-dimer group, the high D-dimer group also had a larger AAR (38.1% [31.7–46.9] versus 35.8% [24.2–45.3]; p = 0.04) and a smaller MSI (37.7 [28.2–46.9] versus 47.1 [33.2–57.0]; p = 0.01). In multivariate analysis, high D-dimer levels were significantly associated with larger myocardial infarct (OR 2.59; 95% CI 1.37–4.87; p<0.01) and lower MSI (OR 2.62; 95% CI 1.44–4.78; p<0.01). Conclusions In STEMI patients undergoing primary PCI, high D-dimer levels on admission were associated with a larger myocardial infarct size, a greater extent of AAR, and lower MSI, as assessed by CMR data. Elevated initial D-dimer level may be a marker of advanced myocardial injury in patients treated with primary PCI for STEMI.
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Affiliation(s)
- Soonuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Jin Jang
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Joao A. C. Lima
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Eliseo Guallar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Yeon Hyeon Choe
- Department of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Kyung Hwang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Gong P, Yang SH, Li S, Luo SH, Zeng RX, Zhang Y, Guo YL, Zhu CG, Xu RX, Li JJ. Plasma d-Dimer as a Useful Marker Predicts Severity of Atherosclerotic Lesion and Short-Term Outcome in Patients With Coronary Artery Disease. Clin Appl Thromb Hemost 2016; 22:633-40. [PMID: 26936933 DOI: 10.1177/1076029616634885] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Increased d-dimer is indicative of a hypercoagulable state and found to be associated with acute coronary syndromes. The present study aimed to evaluate whether plasma d-dimer levels could predict subsequent major clinical events in patients with coronary artery disease (CAD). First, 2209 angiographic-proven patients with CAD were consecutively enrolled. Then, all patients were subjected to follow up for an average of 18 months (ranged from 14 to 1037 days). The relationships of the plasma d-dimer with the severity of CAD and future clinical outcomes were evaluated. We found that plasma d-dimer was higher in patients with prior myocardial infarction (MI) than that in patients with nonprior MI (P = .006). Multivariate linear regression analysis suggested that the plasma d-dimer was linked to the severity of CAD assessed by Gensini score (β = 0.052, 95% confidence interval [CI]: 1.20-6.84, P = .005) even after adjusting for confounding factors. During the follow-up, 42 patients underwent prespecified outcomes. After adjustment for multiple variables in the Cox regression model, the d-dimer levels remained to be a potential predictor of total outcome (hazard ratio = 1.22, 95% CI: 1.09-1.37, P = .001). Therefore, plasma d-dimer levels appeared to be a useful predictor for the severity of CAD and the subsequent major clinical events.
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Affiliation(s)
- Ping Gong
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China Department of Cardiology, The Fifth Hospital of Wuhan & Affiliated Guangci Hospital of Wuhan University, Wuhan, China
| | - Sheng-Hua Yang
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Sha Li
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Song-Hui Luo
- Department of Cardiology, The Fifth Hospital of Wuhan & Affiliated Guangci Hospital of Wuhan University, Wuhan, China
| | - Rui-Xiang Zeng
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Yan Zhang
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Yuan-Lin Guo
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Cheng-Gang Zhu
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Rui-Xia Xu
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
| | - Jian-Jun Li
- Center for Dyslipidemia and Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, XiCheng District, Beijing, China
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Kinetics of coagulation in ST-elevation myocardial infarction following successful primary percutaneous coronary intervention. Thromb Res 2016; 137:64-71. [DOI: 10.1016/j.thromres.2015.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/24/2015] [Accepted: 11/14/2015] [Indexed: 01/24/2023]
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Hansen CH, Ritschel V, Halvorsen S, Andersen GØ, Bjørnerheim R, Eritsland J, Arnesen H, Seljeflot I. Markers of thrombin generation are associated with myocardial necrosis and left ventricular impairment in patients with ST-elevation myocardial infarction. Thromb J 2015; 13:31. [PMID: 26396552 PMCID: PMC4578351 DOI: 10.1186/s12959-015-0061-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/12/2015] [Indexed: 12/18/2022] Open
Abstract
Introduction Platelet activation, thrombin generation and fibrin formation play important roles in intracoronary thrombus formation, which may lead to acute myocardial infarction. We investigated whether the prothrombotic markers D-dimer, pro-thrombin fragment 1 + 2 (F1 + 2) and endogenous thrombin potential (ETP) are associated with myocardial necrosis assessed by Troponin T (TnT), and left ventricular impairment assessed by left ventricular ejection fraction (LVEF) and N-terminal pro b-type natriuretic peptide (NT-proBNP). Materials/Methods Patients (n = 987) with ST-elevation mycardial infarction (STEMI) were included. Blood samples were drawn at a median time of 24 h after onset of symptoms. Results Statistically significant correlations were found between both peak TnT and D-dimer (p < 0.001) and F1 + 2 (p < 0.001), and between NT-proBNP and D-dimer (p = 0.001) and F1 + 2 (p < 0.001). When dividing TnT and NT-proBNP levels into quartiles there were significant trends for increased levels of both markers across quartiles (all p < 0.001) D-dimer remained significantly associated with NT-proBNP after adjustments for covariates (p = 0.001) whereas the association between NTproBNP and F1 + 2 was no longer statistically significant (p = 0.324). A significant inverse correlation was found between LVEF and D-dimer (p < 0.001) and F1 + 2 (p = 0.013). When dichotomizing LVEF levels at 40 %, we observed significantly higher levels of both D-dimer (p < 0.001) and F1 + 2 (p = 0.016) in the group with low EF (n = 147). Summary/conclusion In our cohort of STEMI patients we demonstrated that levels of D-dimer and F1 + 2 were significantly associated with myocardial necrosis as assessed by peak TnT. High levels of these coagulation markers in patients with low LVEF and high NTproBNP may indicate a hypercoagulable state in patients with impaired myocardial function.
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Affiliation(s)
- C H Hansen
- Center for Clinical Heart Research, Oslo University Hospital Ullevål, PB 4956 Nydalen, N-4956 Oslo, Norway ; Departement of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - V Ritschel
- Center for Clinical Heart Research, Oslo University Hospital Ullevål, PB 4956 Nydalen, N-4956 Oslo, Norway ; Departement of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway ; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - S Halvorsen
- Departement of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway ; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - G Ø Andersen
- Center for Clinical Heart Research, Oslo University Hospital Ullevål, PB 4956 Nydalen, N-4956 Oslo, Norway ; Departement of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - R Bjørnerheim
- Departement of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - J Eritsland
- Departement of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - H Arnesen
- Center for Clinical Heart Research, Oslo University Hospital Ullevål, PB 4956 Nydalen, N-4956 Oslo, Norway ; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - I Seljeflot
- Center for Clinical Heart Research, Oslo University Hospital Ullevål, PB 4956 Nydalen, N-4956 Oslo, Norway ; Departement of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway ; Faculty of Medicine, University of Oslo, Oslo, Norway
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