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.
Highlights
D-dimer is a biomarker of thrombosis and hypercoagulability; it can be measured in plasma or whole blood [1, 2]
Acute STsegment elevation myocardial infarction (MI) (STEMI) was defined as follows: chest pain typically lasts more than 30 minutes, and ST-segment elevation of adjacent two electrocardiography leads at least 2 mm within 12 hours of symptom onset [15]
The results showed that variables such as age, heart rate, and white blood cell (WBC) count were independent factors of in-hospital Heart failure (HF) (Table 3)
Summary
D-dimer is a biomarker of thrombosis and hypercoagulability; it can be measured in plasma or whole blood [1, 2]. Previous studies showed that D-dimer levels could predict adverse outcomes, including fatal events in patients with coronary heart disease (CHD), in terms of both short-term outcomes and long-term follow-up [5,6,7,8,9,10]. Previous studies demonstrated that D-dimer levels were more predictive for cardiac events in patients with acute MI; HF was not included [8, 13, 14]. The role of D-dimer level in predicting in-hospital HF in patients with STsegment elevation MI (STEMI) is not clear, after primary percutaneous coronary intervention (pPCI). The present analysis was performed to evaluate the possible relationship between D-dimer levels and incidence of in-hospital HF in patients with STEMI undergoing pPCI in the overall population and in subgroups with gender difference
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