Association Between Admission D-Dimer Levels and Coronary Anatomical Complexity Assessed by the SYNTAX Score in Patients With Acute Coronary Syndrome

Q: What are the key findings of this study?

Admission D-dimer correlated positively with SYNTAX score (r=0.385, p<0.001) in ACS patients, but was not an independent predictor of high SYNTAX score (≥33) in multivariable analysis (OR 1.891, p=0.200).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome undergoing percutaneous coronary intervention (n=388). Intervention: Admission plasma D-dimer level (≥0.5 µg/mL FEU) vs. Admission plasma D-dimer level (<0.5 µg/mL FEU). Primary outcome: High coronary anatomical complexity defined as SYNTAX score ≥33 (OR 1.891, 95% CI 0.845-6.062, p=0.200).

Q: What does this research mean for the field?

In patients presenting with acute coronary syndrome, admission plasma D-dimer levels positively correlate with coronary anatomical complexity assessed by the SYNTAX score, but D-dimer is not an independent predictor of high SYNTAX scores after multivariable adjustment. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mustafa Öcal; Erdem Öztürk

doi:10.54996/anatolianjem.1806445

June 28, 2026Anatolian Journal of Emergency MedicineOpen Access

Association Between Admission D-Dimer Levels and Coronary Anatomical Complexity Assessed by the SYNTAX Score in Patients With Acute Coronary Syndrome

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Key result

Admission D-dimer correlates with SYNTAX score in ACS but fails to independently predict high complexity.

OR 1.891
95% CI 0.845-6.062
P=0.200
n=388

Why the study?

The association between D-dimer levels and coronary anatomical complexity in acute coronary syndrome remains incompletely characterized.

Does admission plasma D-dimer level predict high coronary anatomical complexity (SYNTAX score ≥33) in patients with acute coronary syndrome undergoing percutaneous coronary intervention?

Key Points

To evaluate the association between admission plasma D-dimer levels and coronary anatomical complexity assessed by the SYNTAX score in patients with acute coronary syndrome.
Retrospective analysis of 388 patients with acute coronary syndrome who underwent percutaneous coronary intervention.
Patients were categorized by admission D-dimer levels (<0.5 µg/mL FEU vs. ≥0.5 µg/mL FEU) and SYNTAX score categories (low: 0–22, intermediate: 23–32, high: ≥33), alongside admission high-sensitivity troponin I measurements.
D-dimer levels showed a significant positive correlation with SYNTAX scores (r = 0.385, p < 0.001); among patients with D-dimer <0.5 µg/mL FEU, 83.9% had low SYNTAX scores, while 5.1% had high scores.
Receiver operating characteristic analysis demonstrated an AUC of 0.70 (95% CI: 0.64–0.77) for D-dimer in identifying high SYNTAX scores, yielding 83% sensitivity and 59% specificity at a cut-off of 0.78 µg/mL FEU.
On multivariable logistic regression adjusted for age, creatinine, and log-transformed troponin, D-dimer was not an independent predictor of high SYNTAX score (OR: 1.891; 95% CI: 0.845–6.062; p = 0.200), whereas log(Hs-TnI) remained independently significant (OR: 1.195; 95% CI: 1.014–1.391; p = 0.024).

Study Design

Type

Cohort (n=388)

Multicenter

No

Structured PICO

Does admission plasma D-dimer level predict high coronary anatomical complexity (SYNTAX score ≥33) in patients with acute coronary syndrome undergoing percutaneous coronary intervention?

P

Population

388 patients (mean age 61.6 years, range 34-89) presenting with acute coronary syndrome who underwent percutaneous coronary intervention at a single center in Turkey.

E

Exposure

Admission plasma D-dimer measurement (categorized as ≥0.5 µg/mL FEU vs. <0.5 µg/mL FEU, with an optimal ROC cut-off of 0.78 µg/mL FEU) and admission high-sensitivity troponin I (Hs-TnI) measurement

C

Comparator

Patients with admission D-dimer <0.5 µg/mL FEU (internal cohort comparison; also compared against high-sensitivity troponin I, creatinine, and age in ROC and multivariable models)

O

Outcome

Coronary anatomical complexity quantified by the angiographic SYNTAX score (categorized as low: 0–22, intermediate: 23–32, and high: ≥33)surrogate

Main Result

Odds Ratio: 1.891 (95% CI 0.845–6.062)

Absolute Event Rate: 16.3% vs 5.1%

p-value: p=0.200

In patients with acute coronary syndrome undergoing PCI, admission D-dimer moderately correlates with SYNTAX scores and offers 83% sensitivity for ruling out high anatomical complexity, though it is not an independent predictor after adjusting for high-sensitivity troponin I.

Limitations

Retrospective, single-center design and inclusion of only PCI-treated patients limit generalizability to patients managed conservatively or referred for CABG
Potential residual confounding by comorbid conditions that influence D-dimer levels
D-dimer was not an independent predictor of high SYNTAX score in multivariable analysis
Lack of established age-adjusted D-dimer thresholds for ACS risk stratification
Did not evaluate long-term clinical outcomes such as mortality or major adverse cardiovascular events (MACE)
Other inflammatory and thrombotic markers were not concurrently analyzed
Retrospective, single-center design and inclusion of only PCI-treated patients may limit generalizability
Residual confounding from comorbid conditions influencing D-dimer levels cannot be entirely excluded

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Implication

D-dimer is not an independent predictor of high SYNTAX score in ACS; leaves open incremental value beyond hs-TnI in prospective cohorts.

Abstract

Aim: D-dimer is a fibrin degradation product reflecting intravascular thrombotic activity. The SYNTAX score is an angiographic tool quantifying coronary anatomical complexity. The association between D-dimer levels and coronary anatomical complexity in acute coronary syndrome (ACS) remains incompletely characterized. This study aimed to evaluate the association between plasma D-dimer levels and SYNTAX scores in patients presenting with acute coronary syndrome (ACS).Material and Methods: A total of 388 patients with ACS who underwent percutaneous coronary intervention (PCI) were retrospectively analyzed. Patients were categorized based on D-dimer levels (<0.5 µg/mL FEU and ≥0.5 µg/mL FEU) and SYNTAX score classifications (low: 0–22, intermediate: 23–32, high: ≥33). High-sensitivity troponin I (Hs-TnI) was also measured at admission. Correlation analyses, binary logistic regression, and ROC curve assessments were performed.Results: D-dimer levels showed a significant positive correlation with SYNTAX scores (r = 0.385, p < 0.001). Among patients with D-dimer <0.5 µg/mL FEU, 83.9% had low SYNTAX scores, while only 5.1% had high scores. ROC analysis revealed an AUC of 0.70 (95% CI: 0.64–0.77) for D-dimer in identifying high SYNTAX scores, with 83% sensitivity and 59% specificity at a cut-off of 0.78 µg/mL FEU. In multivariable logistic regression, D-dimer was not an independent predictor of high SYNTAX score after adjustment for age, creatinine, and log-transformed Hs-TnI (OR: 1.891; 95% CI: 0.845–6.062; p = 0.200), whereas log(Hs-TnI) remained independently significant (OR: 1.195; 95% CI: 1.014–1.391; p = 0.024). D-dimer exhibited higher sensitivity than troponin in detecting high anatomical complexity.Conclusion: D-dimer levels show a statistically significant association with coronary anatomical complexity in ACS patients and may serve as a supplementary, non-invasive parameter for early risk stratification. However, D-dimer was not an independent predictor in multivariable analysis, and these findings require prospective multicenter validation before clinical implementation.

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Cite This Study

Öcal et al. (2026) conducted a cohort in Acute coronary syndrome undergoing percutaneous coronary intervention (n=388). Admission plasma D-dimer level (≥0.5 µg/mL FEU) vs. Admission plasma D-dimer level (<0.5 µg/mL FEU) was evaluated on High coronary anatomical complexity defined as SYNTAX score ≥33 (OR 1.891, 95% CI 0.845-6.062, p=0.200). Admission D-dimer correlated positively with SYNTAX score (r=0.385, p<0.001) in ACS patients, but was not an independent predictor of high SYNTAX score (≥33) in multivariable analysis (OR 1.891, p=0.200).

synapsesocial.com/papers/6a435cb3759b888809a530d5 https://doi.org/10.54996/anatolianjem.1806445

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Association Between Admission D-Dimer Levels and Coronary Anatomical Complexity Assessed by the SYNTAX Score in Patients With Acute Coronary Syndrome

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association Between Admission D-Dimer Levels and Coronary Anatomical Complexity Assessed by the SYNTAX Score in Patients With Acute Coronary Syndrome

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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