The prognostic utility of D-dimer and fibrin monomer at long-term follow-up after hospitalization with coronary chest pain

Abstract

D-dimer and fibrin monomer both reflect a prothrombotic potential. There are limited data available comparing these two markers of activated coagulation in a prospective manner in an unselected patient population presenting to the emergency department with chest pain. In addition, their role in risk stratification in patients with acute coronary syndrome is still under evaluation. Therefore, we wanted to assess the prognostic value of these markers with respect to long-term all-cause mortality in 871 patients admitted to the emergency department. Blood samples were obtained immediately following admission. After a follow-up period of 24 months, 123 patients had died. In the univariate analysis, both D-dimer and fibrin monomer predicted all-cause mortality within 2 years with an odds ratio of 7.78 (95% confidence interval, 3.95-15.33) and 4.19 (95% confidence interval, 2.42-7.28), respectively, in the highest quartile (Q4) compared with the lowest quartile (Q1). However, in the multivariable logistic regression model for death within 2 years, the odds ratio of D-dimer and fibrin monomer was 1.80 (95% confidence interval, 0.81 to 3.97) and 1.04 (95% confidence interval, 0.53 to 2.04) in Q4 compared with Q1, respectively, and added no prognostic information above and beyond age, known coronary heart disease, B-type natriuretic peptide and the index diagnoses of ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction and unstable angina pectoris. In an unselected patient population hospitalized with chest pain and potential acute coronary syndrome, neither D-dimer nor fibrin monomer provided complementary prognostic information to established risk determinants during long-term follow-up.

Long-term prognostic utility of pentraxin 3 and D-dimer as compared to high-sensitivity C-reactive protein and B-type natriuretic peptide in suspected acute coronary syndrome

“…However, in several other studies of ACS populations, D-dimer levels did not yield prognostic information. [37][38][39][40] In the present population, D-dimer showed no independent prognostic utility at 2 years of follow-up, 28 but gained prognostic importance during the extended follow-up period, reflecting a gradual progression of disease from silent to clinically evident thrombotic manifestations. In contrast to PTX3, hsCRP did not appear to be an independent predictor of total mortality in our multivariate analysis, but its level was associated with recurrent MI during the follow-up period.…”

“…28 No patients with a positive TnT in their first blood samples were lost for inclusion during the recruitment period, whereas those with chest pain without TnT release were essentially selected according to symptom specificity for ACS as evaluated by the investigator. The main exclusion criteria were age <18 years, unwillingness or incapacity to provide informed consent and prior inclusion in the present study.…”

Prognostic Value of Plasma Fibrinolysis Activation Markers in Cardiovascular Disease

“…In the ADVANCE Study, however, D-dimer did not distinguish patients presenting with AMI from those with stable angina (38). In large prospective studies investigating a multimarker approach to the initial assessment of patients with chest pain, D-dimer did not aid detection of ACS or predict prognosis above and beyond established risk factors (49,50).…”

The Value of d-Dimer Level in Predicting Contrast-Induced Acute Kidney Injury in Patients With Acute ST-Segment Elevation Myocardial Infarction After PCI

“…Some previous studies revealed that d -dimer levels were not predictive of cardiovascular events. 14 , 15 In contrast, Fiotti et al found that d -dimer levels on admission were associated with worse in-hospital prognosis in patients with unstable angina pectoris. 16 Thus, the purpose of this study was to investigate whether d -dimer levels on admission predict CI-AKI after PCI, as well as to evaluate the prognostic value of d -dimer levels in patients with STEMI and to provide ideas for improving STEMI and CI-AKI risk stratification.…”