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

Abstract

D-dimer is a final product of fibrin degradation and gives an indirect estimation of the thrombotic burden. We aimed to investigate the value of plasma D-dimer levels on admission in predicting no-reflow after primary percutaneous coronary intervention (p-PCI) and long-term prognosis in patients with ST segment elevation myocardial infarction (STEMI). We retrospectively involved 569 patients treated with p-PCI for acute STEMIs. We prospectively followed up the patients for a median duration of 38 months. Angiographic no-reflow was defined as postprocedural thrombolysis in myocardial infarction (TIMI) flow grade <3 or TIMI 3 with a myocardial blush grade <2. Electrocardiographic no-reflow was defined as ST-segment resolution <70%. The primary clinical end points were mortality and major adverse cardiovascular events (MACE). The incidences of angiographic and electrocardiographic no-reflow were 31 and 39% respectively. At multivariable analysis, D-dimer was found to be an independent predictor of both angiographic (p < 0.001), and electrocardiographic (p < 0.001) no-reflow. Both mortality (from Q1 to Q4, 5.7, 6.4, 11.3 and 34.1%, respectively, p < 0.001) and MACE (from Q1 to Q4, 17.9, 29.3, 36.9 and 52.2%, respectively, p < 0.001) rates at long-term follow-up were highest in patients with admission D-dimer levels in the highest quartile (Q4), compared to the rates in other quartiles. However, Cox proportional hazard model revealed that high D-dimer on admission (Q4) was not an independent predictor of mortality or MACE. In contrast, electrocardiographic no-reflow was independently predictive of both mortality [Hazard ratio (HR) 2.88, 95% confidence interval (CI) 1.04-8.58, p = 0.041] and MACE [HR 1.90, 95% CI 1.32-4.71, p = 0.042]. In conclusion, plasma D-dimer level on admission independently predicts no-reflow after p-PCI. However, D-dimer has no independent prognostic value in patients with STEMI.

Impaired thrombolytic status predicts adverse cardiac events in patients undergoing primary percutaneous coronary intervention

“…The cut-point of LT that predicts MACE appears to be consistent in our study and prior studies (13,14). Furthermore, D-dimer levels on admission were associated with a higher incidence of no reflow (30) and higher risk of MACE in STEMI patients undergoing PPCI (31) and elevated levels post-PPCI were related to impairment of myocardial function (32). Furthermore, when intracoronary thrombi aspirated during PPCI were examined, increased von Willebrand factor, P-selectin and fibrin content were related to unfavourable thrombus characteristics rendering the thrombus resistant to lytic therapy (33) and denser plasma fibrin clots were independently associated with high fibrin content (34).…”

Predictive value of admission D-dimer for contrast-induced acute kidney injury and poor outcomes after primary percutaneous coronary intervention

“…The potential pathophysiological mechanism may be partly explained by following. First, DD levels were confirmed to be closely related to the occurrence of no-reflow after pPCI [33] indicating that the thrombus is unstable and easily to fall off into the circulation system, which may influence the renal blood flow and further lead to CI-AKI. Second, elevated DD levels is mainly cleared through renal excretion, so higher DD levels often reflect the injury of renal function, which indirectly revealing the decline in the kidney's ability to excrete the contrast agent, further to enhance the direct cytotoxicity of contrast agent.…”

The Value of Combining Plasma D-Dimer and Endothelin-1 Levels to Predict No-Reflow After Percutaneous Coronary Intervention of ST-Segment Elevation in Acute Myocardial Infarction Patients with a Type 2 Diabetes Mellitus History

“…A high D-dimer level was associated with increased in-hospital cardiovascular mortality and 6-month all-cause mortality in patients with STEMI undergoing primary PCI [ 7 ]. In another patient cohort, high plasma D-dimer level on admission was found to be an independent predictor of both angiographic and electrocardiographic no-reflow [ 8 ]. However, the D-dimer level didn’t show prognostic value [ 8 ].…”

“…In another patient cohort, high plasma D-dimer level on admission was found to be an independent predictor of both angiographic and electrocardiographic no-reflow [ 8 ]. However, the D-dimer level didn’t show prognostic value [ 8 ].…”