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Cao S, Liu Y, Ye J, Wang Y, Wang Z, Li C, Jin T, Wu J, Zong G. The value of D-dimer to lymphocyte ratio in predicting clinical outcomes after percutaneous coronary intervention in ST-segment elevation myocardial infarction patients: A retrospective study. Int Immunopharmacol 2024; 128:111556. [PMID: 38241843 DOI: 10.1016/j.intimp.2024.111556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND D-dimer to lymphocyte ratio (DLR) is a novel composite metric. This study investigated the association between DLR and major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention. MATERIALS AND METHODS This retrospective study included 683 STEMI cases treated between January 2018 and June 2021 at a single center. DLR was calculated for each patient. Receiver operating characteristic curves assessed the predictive value of in-hospital and long-term MACEs, with calculated AUC. Based on the optimal DLR cutoff value, the population was categorized into groups for clinical characteristic analysis. Multivariate logistic and COX regression analyses determined factors independently associated with MACEs. Kaplan-Meier estimation method and log-rank tests assessed event-free survival among different DLR groups. Spearman's test explored the correlation between DLR and Gensini score. RESULTS DLR demonstrated an AUC of 0.792 for predicting in-hospital MACEs and 0.708 for long-term MACEs in patients with STEMI. Multivariate logistic regression analysis revealed that a high DLR (cutoff value, 0.47) independently increased the risk of MACEs during hospitalization in patients with STEMI (P = 0.003; odds ratio: 3.015; 95 % CI: 1.438-6.321). Multivariate COX regression showed that a high DLR (cutoff value, 0.34) independently predicted MACEs during long-term follow-up in patients with STEMI (P = 0.011; hazard ratio: 1.724; 95 % CI: 1.135-2.619). Furthermore, DLR exhibited a positive correlation with the Gensini score (P < 0.001). CONCLUSIONS DLR is a valuable predictor for MACEs occurrence in patients with STEMI during hospitalization and long-term follow-up after PCI.
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Affiliation(s)
- Shaoqing Cao
- Wuxi Clinical College of Anhui Medical University, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Anhui medical university fifth clinical medical college, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Yehong Liu
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Jiangping Ye
- Wuxi Clinical College of Anhui Medical University, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Anhui medical university fifth clinical medical college, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Yuqin Wang
- Wuxi Clinical College of Anhui Medical University, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Anhui medical university fifth clinical medical college, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Zhangyu Wang
- Wuxi Clinical College of Anhui Medical University, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Anhui medical university fifth clinical medical college, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Chengsi Li
- Wuxi Clinical College of Anhui Medical University, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Anhui medical university fifth clinical medical college, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Tianhui Jin
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Jiayu Wu
- Neurology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China
| | - Gangjun Zong
- Wuxi Clinical College of Anhui Medical University, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Anhui medical university fifth clinical medical college, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China; Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, No.101 Xingyuan North Road, Beidajie Street, Liangxi District, Wuxi, Jiangsu Province, 214000, China.
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Jain A, Desai R, Shenwai P, Akah O, Bansal P, Ghimire S, Ghimire S, Vyas A, Gupta P, Badheka A. Impact of D-dimer levels on no-reflow phenomenon following percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis. Acta Cardiol 2023; 78:970-973. [PMID: 35787242 DOI: 10.1080/00015385.2022.2097346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Akhil Jain
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, PA, USA
| | - Rupak Desai
- Independent Outcomes Researcher, Atlanta, GA, USA
| | - Priya Shenwai
- Department of Anesthesiology, Netaji Subhash Chandra Bose Medical College, Jabalpur, India
| | - Ozo Akah
- Department of Internal Medicine, Carnegie Mellon University, Houston, TX, USA
| | - Prerna Bansal
- Department of Medicine, Pravar Institute of Medical Sciences, Ahmednagar, Maharashtra, India
| | - Samir Ghimire
- Department of Forensic Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Shristee Ghimire
- Department of Internal Medicine, Jewish Hospital, Louisville, KY, USA
| | - Ankit Vyas
- Department of Internal Medicine, Baptist Hospitals of Southeast Texas Beaumont, Beaumont, TX, USA
| | - Puneet Gupta
- Division of Cardiology, Baptist Health Deaconess Madisonville, Madisonville, KY, USA
| | - Apurva Badheka
- Division of Cardiology, Washington State University, Washington, DC, USA
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Zhang Q, Hu M, Ma S, Niu T. New R 2-CHA 2DS 2-VASc score predicts no-reflow phenomenon and long-term prognosis in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention. Front Cardiovasc Med 2022; 9:899739. [PMID: 36312233 PMCID: PMC9609412 DOI: 10.3389/fcvm.2022.899739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Aims Evaluating the prognostic validity of new R2-CHA2DS2-VASc score for no-reflow phenomena and long-term prognosis in patients following primary percutaneous coronary intervention (PCI) with ST-elevation myocardial infarction (STEMI). Materials and methods From January 2017 to December 2018, a total of 401 patients with STEMI were continuously enrolled. According to the cut-off value, the patients were separated into two groups: R2-CHA2DS2-VASc < 3 group (n = 275) and R2-CHA2DS2-VASc ≥ 3 group (n = 126). Results With a sensitivity of 52.6% and a specificity of 73.1%, the optimal cut-off value for predicting no-reflow is R2-CHA2DS2-VASc ≥ 3. R2-CHA2DS2-VASc ≥ 3 as the ideal cut-off value for predicting major adverse cardiovascular events (MACE) with an area under the curve (AUC) of 0.781 [95% Confidence interval (CI): 0.738–0.801, P 0.001], a sensitivity of 50%, and a specificity of 91.1%. The incidence of MACE, death from all causes, and worsening heart failure was greater in the R2-CHA2DS2-VASc ≥ 3 group, although there was no significant difference in the incidence of repeated revascularisation procedures following PCI between the two groups. R2-CHA2DS2-VASc ≥ 3 was also an independent predictor of MACE (hazard ratio = 2.48, 95% confidence interval CI: 1.33–4.62, P = 0.04). Moreover, this score has a greater sensitivity (66.7%) and specificity (88.7%) for predicting the progression of heart failure. Conclusion R2-CHA2DS2-VASc ≥ 3 was independently associated with no-reflow phenomenon and poor clinical outcomes for patients in STEMI after primary PCI.
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Li Q, Xie E, Tu Y, Wu Y, Guo Z, Li P, Li Y, Yu X, Ye Z, Yu C, Gao Y, Jingang Z. Association between kaolin-induced maximum amplitude and slow-flow/no-reflow in ST elevation myocardial infarction patients treated with primary percutaneous coronary intervention. Int J Cardiol 2022; 369:13-18. [PMID: 35970443 DOI: 10.1016/j.ijcard.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/08/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) patients with a high thrombus burden have a relatively high slow-flow/no-reflow risk. However, the association between kaolin-induced maximum amplitude (MAthrombin) and slow-flow/no-reflow has been scarcely explored. METHODS STEMI patients treated with primary percutaneous coronary intervention (PCI) were retrospectively enrolled from January 2015 to December 2019 at China-Japan Friendship Hospital. MAthrombin levels were measured using thromboelastography before the PCI procedure. The patients were divided into two groups according to thrombolysis in myocardial infarction (TIMI) flow grade after primary PCI: the normal flow group (TIMI flow grade = 3) and slow-flow/no-reflow (TIMI flow grade ≤ 2). The logistic regression model and restricted cubic spline regression (RCS) were used to analyze the predictive value of MAthrombin for slow-flow/no-reflow. All patients were followed up after discharge and observed the adverse cardiovascular events between the two groups. RESULTS A total of 690 patients were enrolled, with 108(15.7%) having slow-flow/no-reflow. The multivariate logistic regression model analysis showed that MAthrombin level was an independent risk factor for slow-flow/no-reflow. The RCS analysis showed a nonlinear relationship between MAthrombin levels and slow-flow/no-reflow. The cut-off value of MAthrombin levels for predicting slow-flow/no-reflow was 68 mm. During a median follow-up time of 4.4 years, slow-flow/no-reflow (hazard ratio 1.93, 95% confidence interval 1.27-2.93, P = 0.002) and MAthrombin levels (hazard ratio 1.06, 95% confidence interval 1.03-1.08, P < 0.001) were independent risk factors for predicting the long-term of adverse clinical cardiovascular events. CONCLUSION MAthrombin was an independent risk factor for predicting slow-flow/ no-reflow in STEMI patients who underwent primary PCI.
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Affiliation(s)
- Qing Li
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Enmin Xie
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yimin Tu
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yaxin Wu
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Ziyu Guo
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Peizhao Li
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yike Li
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xiaozhai Yu
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zixiang Ye
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Changan Yu
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yanxiang Gao
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Zheng Jingang
- Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China; China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China; Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.
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5
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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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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 Economics and Finance, University of Rome "Tor Vergata", Via Columbia 2, 00133, Rome, Italy
| | - Alessio Farcomeni
- Department of General and Specialized Surgery "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, 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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Wu R, Gao W, Dong Z, Su Y, Ji Y, Liao J, Ma Y, Dai Y, Yao K, Ge J. Plasma Heat Shock Protein 70 Is Associated With the Onset of Acute Myocardial Infarction and Total Occlusion in Target Vessels. Front Cardiovasc Med 2021; 8:688702. [PMID: 34631810 PMCID: PMC8494979 DOI: 10.3389/fcvm.2021.688702] [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: 03/31/2021] [Accepted: 08/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Whether the role of plasma heat shock protein 70 (HSP70) in acute myocardial infarction (AMI) is protective or detrimental remains debated, and the relationship between HSP70 and total occlusion remains elusive. Methods: A total of 112 patients with primary diagnosis of AMI and 52 patients with chronic coronary syndrome (CCS) were enrolled into the study. Plasma HSP70 level was determined by ELISA on day 1 and day 7 after the onset of AMI and was examined before angiography in patients with CCS. Peak NT-proBNP, high-sensitivity C-reactive protein (CRP), troponin T (cTnT), and left ventricular ejection fraction were measured. Results: Plasma HSP70 was significantly higher in CCS than AMI (P < 0.0001), and it showed a significant decrease from day 1 to day 7 after AMI (P < 0.01). Elevated HSP70 was associated with decreased levels of LDL-C (P < 0.05), peak cTnT (R = −0.3578, P < 0.0001), peak NT-proBNP (R = −0.3583, P < 0.0001), and peak CRP (R = −0.3539, P < 0.0001) and a lower diagnosis of AMI (R = −0.4016, P < 0.0001) and STEMI (R = −0.3675, P < 0.0001), but a higher diagnosis of total occlusion in target vessels (R = 0.1702, P < 0.05). HSP70 may provide certain predictive value for the diagnosis of AMI, STEMI, and total occlusion in target vessels, and the area under the receiver operating characteristic curves were 0.7660, 0.7152, and 0.5984, respectively. HSP70 was also negatively associated with in-hospital stay (P < 0.001) and positively correlated with left ventricular ejection fraction (LVEF) at 1-year follow-up (P < 0.05), despite no association with in-hospital major adverse cardiovascular events (MACE). Conclusion: Plasma HSP70 level was found to decrease from day 1 to day 7 post-AMI, but the overall level of patients with AMI was lower than that of patients with CCS. However, the ability of HSP70 to identify clinically significant AMI and STEMI was moderate, and the predictive value to total occlusion was slight.
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Affiliation(s)
- Runda Wu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Wei Gao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Zheng Dong
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Ya Su
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Yuyao Ji
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Jianquan Liao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Yuanji Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Yuxiang Dai
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Kang Yao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Disease, Shanghai, China.,National Health Commission Key Laboratory of Viral Heart Diseases, Fudan University, Shanghai, China.,Key Laboratory of Viral Heart Diseases, Chinese Academy of Medical Sciences, Beijing, China
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8
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Diao Y, Yin M, Zhang B, Sun B. Predictive value of N-terminal pro-B-type natriuretic peptide (NT-pro BNP) combined with D-dimer for no-reflow phenomenon in patients with acute coronary syndrome after emergency of percutaneous coronary intervention. Bioengineered 2021; 12:8614-8621. [PMID: 34612772 PMCID: PMC8806976 DOI: 10.1080/21655979.2021.1988361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Acute coronary syndrome (ACS) is a critical illness in cardiovascular disease. The purpose of this study was to investigate the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and D-dimer in predicting the occurrence of no reflow in emergency percutaneous coronary intervention (PCI) in patients with ACS. One hundred and sixty-eight ACS patients were recruited, including 88 patients with normal reflow and 80 patients with no reflow after emergency PCI. The levels of serum NT-proBNP and D-dimer in the patients were detected before PCI, immediately after PCI, 2 hours, and 6 months after PCI. The ROC curve was used to evaluate the predictive value of NT-proBNP and D-dimer in no-reflow phenomenon. Logistic regression model was used to analyze the independent influencing factors of no reflow phenomenon. Logistic regression analysis confirmed that NT-proBNP and D-dimer were independent predictors of the occurrence of no reflow in the total population. The ROC curve showed that the AUC value was 0.909 when NT-proBNP combined with D-dimer. The detection of NT-proBNP combined with D-dimer was helpful to predict the occurrence of no-reflow phenomenon after emergency PCI in ACS patients.
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Affiliation(s)
- Yujing Diao
- Department of Emergency, Yidu Central Hospital of Weifang, Weifang, Shandong, China
| | - Meifeng Yin
- Department of Emergency, Yidu Central Hospital of Weifang, Weifang, Shandong, China
| | - Baoguo Zhang
- Clinical Internal Medicine, Qingzhou Mihe Central Health Center, Shandong, Weifang, China
| | - Bin Sun
- Department of Emergency, Yidu Central Hospital of Weifang, Weifang, Shandong, China
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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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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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11
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Zhao X, Lan J, Yu X, Zhou J, Tan Y, Sheng Z, Li J, Wang Y, Chen R, Liu C, Zhou P, Chen Y, Song L, Zhao H, Yan H. Primary Percutaneous Coronary Intervention in Patients With Type 2 Diabetes With Late/Very Late Stent Thrombosis and de novo Lesions: A Single-Center Observational Cohort Study of Clinical Outcomes and Influencing Factors. Front Cardiovasc Med 2021; 8:653467. [PMID: 34239902 PMCID: PMC8258412 DOI: 10.3389/fcvm.2021.653467] [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: 01/14/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background: This study compared differences in the risk factors and clinical outcomes of primary percutaneous coronary intervention (PCI) in type 2 diabetes mellitus (DM) and non-DM patients with de novo lesions (DNLs) and late or very late stent thrombosis (LST/VLST). Methods: We used angiography to screen 4,151 patients with acute coronary syndrome for DNL and LST/VLST lesions. Overall, 3,941 patients were included in the analysis and were allocated to the DM (n = 1,286) or non-DM (n = 2,665) group at admission. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), defined as death, myocardial infarction, revascularization, and ischemic stroke, within a median follow-up period of 698 days. Results: In the group with a total white blood cell count >10 × 109/L (P = 0.004), a neutral granular cell count >7 × 109/L (P = 0.030), and neutrophil–lymphocyte ratio >1.5 (P = 0.041), revascularization was better for DNL than for LST/VLST lesions. Among DM patients with DNLs, each unit increase in age was associated with a 53.6% increase in the risk of MACEs [hazard ratio (HR): 1.536, 95% confidence interval (CI), 1.300–1.815, P < 0.0001]. Older age (≥65 years) was associated with a significantly greater risk of MACEs (P < 0.0001). Furthermore, each standard deviation (SD) increase in the level of peak white blood cell counts was associated with a 50.1% increase in the risk of MACEs (HR, 1.501; 95% CI, 1.208–1.864; P = 0.0002). When stratifying the DM population with DNLs according to the D-dimer baseline and peak levels <0.5 vs. ≥0.5 mg/L, the high D-dimer group at baseline had a 2.066-fold higher risk of MACEs (P < 0.0001), and the high peak level D-dimer group had a 1.877-fold higher risk of MACEs (P = 0.001) compared to the low-level groups. Among DM patients with LST/VLST, each unit increase in age was associated with a 75.9% increase in the risk of MACEs (HR: 1.759, 95% CI, 1.052–2.940, P = 0.032). Furthermore, for each SD increase in the peak D-dimer level, the risk of MACEs increased by 59.7% (HR, 1.597; 95% CI, 1.110–2.295; P = 0.041). Conclusion: Following successful primary PCI, the measurement of baseline and peak D-dimer values may help identify individuals at high cardiovascular risk. This suggests a potential benefit of lowering D-dimer levels among T2DM patients with DNL. Furthermore, age and the peak D-dimer values may facilitate the risk stratification of T2DM patients with LST/VLST.
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Affiliation(s)
- Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Jun Lan
- Department of Cardiovascular Medicine and Dongguan Cardiovascular Institute, Songshan Lake (SSL) Central Hospital of Dongguan City, The Third People's Hospital of Dongguan City, Affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan, China
| | - Xiaoping Yu
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Yu Tan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China.,Peking Union Medical College and Chinese Academy of Medical Sciences, Xiamen University, Fujian, China
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China.,Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Hongbing Yan
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China.,Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China.,Department of Cardiovascular Medicine and Dongguan Cardiovascular Institute, Songshan Lake (SSL) Central Hospital of Dongguan City, The Third People's Hospital of Dongguan City, Affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan, China
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12
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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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Dietary Supplementation with Selenium and Coenzyme Q 10 Prevents Increase in Plasma D-Dimer While Lowering Cardiovascular Mortality in an Elderly Swedish Population. Nutrients 2021; 13:nu13041344. [PMID: 33920725 PMCID: PMC8073286 DOI: 10.3390/nu13041344] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/02/2021] [Accepted: 04/13/2021] [Indexed: 12/27/2022] Open
Abstract
A low intake of selenium is associated with increased cardiovascular mortality. This could be reduced by supplementation with selenium and coenzyme Q10. D-dimer, a fragment of fibrin mirroring fibrinolysis, is a biomarker of thromboembolism, increased inflammation, endothelial dysfunction and is associated with cardiovascular mortality in ischemic heart disease. The objective was to examine the impact of selenium and coenzyme Q10 on the level of D-dimer, and its relationship to cardiovascular mortality. D-dimer was measured in 213 individuals at the start and after 48 months of a randomised double-blind placebo-controlled trial with selenium yeast (200 µg/day) and coenzyme Q10 (200 mg/day) (n = 106) or placebo (n = 107). The follow-up time was 4.9 years. All included individuals were low in selenium (mean 67 μg/L, SD 16.8). The differences in D-dimer concentration were evaluated by the use of T-tests, repeated measures of variance and ANCOVA analyses. At the end, a significantly lower D-dimer concentration was observed in the active treatment group in comparison with those on placebo (p = 0.006). Although D-dimer values at baseline were weakly associated with high-sensitive CRP, while being more strongly associated with soluble tumour necrosis factor receptor 1 and sP-selectin, controlling for these in the analysis there was an independent effect on D-dimer. In participants with a D-dimer level above median at baseline, the supplementation resulted in significantly lower cardiovascular mortality compared to those on placebo (p = 0.014). All results were validated with a persisting significant difference between the two groups. Therefore, supplementation with selenium and coenzyme Q10 in a group of elderly low in selenium and coenzyme Q10 prevented an increase in D-dimer and reduced the risk of cardiovascular mortality in comparison with the placebo group. The obtained results also illustrate important associations between inflammation, endothelial function and cardiovascular risk.
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