The value of plasma D-dimer level in predicting no-reflow after primary percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction

Abstract

Abstract Background The no-reflow phenomenon is defined as the occurrence of areas with extremely low tissue flow after reopening the target vessel. Current knowledge suggests that the no-reflow phenomenon is caused by the damage to microvascular integrity established both during ischemia and during reperfusion.. D-dimer is a final product of fibrin degradation by plasmin, the plasma concentrations of which increase in subjects with ongoing or recent thrombosis; its levels reflect the fibrin turnover and gives an indirect estimation of the size of the thrombotic mass available for fibrinolysis and the severity of hypercoagulable state. Moreover, high thrombus burden is known to be associated with no-reflow phenomenon. Objective: To determine the value of plasma D-dimer level on admission in predicting no-reflow after primary percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction, Patients and Methods The study was conducted among 100 patients with STEMI admitted in coronary care unit and coronary catheterization lab unit of cardiology department in Ain Shams University Hospital & Misr University Hospital undergone successful primary PCI. 74 patients showed normal re-flow after PCI and 26 patients showed noreflow phenomenon after PCI and D –dimer level and other clinical parematers for the no re-flow phenomenon were analysed. Results patient with high plasma D-dimer levels showed higher risk of no-reflow phenomenon compared with patients with low plasma D-dimer in predicting no-reflow. D-dimer level ranged from 210 to 776 ng/ml with mean± SD was 415.35 ± 164.91 ng/ml. (55%) of the patients had D-dimer levels <500 ng/ml.and (45%) had D-dimer >500ng/dl. coronary angiography showed that (74%) showed normal flow and (26%)showed no re-flow. ROC curve of the relation of no-reflow, TIMI flow and MBG grade, showed that the best cut off point for D-dimer to detect cases with no reflow was found ≥ 560 with sensitivity of 96.15%, specificity of 79.73% and area under curve (AUC) of 86.5%. Conclusion D-dimer level on admission independently predicts no-reflow after p-PCI. High D-dimer level on admission has an independent prognostic value.