Dong Huang1, Wei Gao1, Runda Wu1, Xin Zhong1, Juying Qian1, Junbo Ge2. 1. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China. 2. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China. Electronic address: jbge@zs-hospital.sh.cn.
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.
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.