Abstract
ObjectivesElevated 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.MethodsWe 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).ResultsIn 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).ConclusionsIn 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.
Highlights
D-dimer is a degradation product of cross-linked fibrin with established clinical utility for diagnosing pulmonary embolism and deep vein thrombosis [1] and could be one of the useful biomarkers for acute myocardial infarction (MI) because ruptured plaque-induced coronary thrombus plays an important role in the pathophysiology of acute MI [2]
In segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), high D-dimer levels on admission were associated with a larger myocardial infarct size, a greater extent of area at risk (AAR), and lower myocardial salvage index (MSI), as assessed by Cardiac magnetic resonance (CMR) data
Elevated initial D-dimer level may be a marker of advanced myocardial injury in patients treated with primary PCI for STEMI
Summary
D-dimer is a degradation product of cross-linked fibrin with established clinical utility for diagnosing pulmonary embolism and deep vein thrombosis [1] and could be one of the useful biomarkers for acute myocardial infarction (MI) because ruptured plaque-induced coronary thrombus plays an important role in the pathophysiology of acute MI [2]. Elevated D-dimer levels on admission were found to predict both adverse cardiovascular events and major bleeding in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) [6]. Another study evaluating the prognostic value of Ddimer in STEMI patients showed that elevated D-dimer levels were associated with in-hospital and mid-term mortality [7]. No attempt has been made to evaluate the impact of Ddimer levels on myocardial injury and salvage in STEMI patients. Cardiac magnetic resonance (CMR) imaging can accurately quantify myocardial ischemic injury and salvaged myocardium, providing a better understanding of the impact of D-dimer in STEMI patients [8, 9].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
