Measurement of D-dimer after the off-pump coronary artery bypass grafting in the patients with non-ST-segment elevation myocardial infarction

Abstract

Objective To study the variation of D-dimer after the off-pump coronary artery bypass grafting(OPCAB), and to evaluate its value for the assessment of postoperative cardiovascular ischemia events. Methods This is a retrospective cohort study. 203 patients with non-ST-segment elevation myocardial infarction(NSTEMI) were random selected from the Tianjin medical university general hospital from 2010 to 2012, including 151 males and 52 females with a mean age of (66.9±8.4) years. The level of D-dimer was analysed by using the Biomerieux VIDAS fluor-euzymelinked immunoassay Analyzer assay. Receiver operating characteristic curve(ROC) was used to evaluate the sensitivity and specificity, the relevance between D-dimer and clinical pathological factors was analysed by χ2 test, the effect on prognosis was evaluated by using cox regression analysis model. Results Compared the group with stable disease, the level of D-dimer was increased remarkable in the group with poor recovery on the 14th day after surgery, (U=75.09, P<0.01). The optimum cut-off point with D-dimer(the 14th day after surgery) for the diagnosis of ischemic events within the 31th-90th day after surgery was 2 590μg/L, the area under ROC curve was 0.867(95% confidence interval:0.791-0.943). The logistic analysis showed that the D-dimer was influenced by the sex, age, left ventricular ejection fraction, left main coronary artery disease, the number of vascular with bypass grafts, using internal mammary artery, hypertension and other factors, OR value was 0.495(95% CI：0.327-0.694), 0.527(95% CI：0.370-0.812), 0.564(95% CI：0.419-0.638), 0.331(95% CI：0.278-0.426), 0.592(95% CI：0.440-0.785), 2.093(95% CI：1.533-2.856), 0.580(95% CI：0.451-0.709) respectively(P<0.01). The Cox analysis showed that the level of D-dimer on the 14th day after surgery was not the independent assessment parameter for long-term prognosis. Conclusion The serum D-dimer was influenced by multiple pathological factors after the OPCAB, the level of serum D-dimer(on the 14th day after surgery) could be used as effective estimate parameter for the adverse events within the 31th-90th after OPCAB. （Chin J Lab Med，2014,37：222-226） Key words: Myocardial infarction; Coronary artery bypass, off-pump; D-dimer