Key result
High D-dimer levels on admission in STEMI patients undergoing primary PCI were significantly associated with a larger myocardial infarct size (OR 2.59) and lower myocardial salvage index.
Why the study?
Are high D-dimer levels on admission associated with larger myocardial infarct size and advanced myocardial injury in STEMI patients undergoing primary PCI?
Observational (n=208)
No
Are high D-dimer levels on admission associated with larger myocardial infarct size and advanced myocardial injury in STEMI patients undergoing primary PCI?
Elevated D-dimer levels on admission in STEMI patients undergoing primary PCI are associated with larger infarct size and reduced myocardial salvage on CMR, suggesting its utility as a biomarker for advanced myocardial injury.
High D-dimer on admission flags STEMI patients at risk for larger infarcts post-PCI; extends its prognostic role in acute coronary syndromes.
OBJECTIVES: Elevated D-dimer levels on admission predict prognosis in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), but the association of D-dimer levels with structural markers of myocardial injury in these patients is unknown. METHODS: We performed cardiac magnetic resonance (CMR) imaging in 208 patients treated with primary PCI for STEMI. CMR was performed a median of 3 days after the index procedure. Of the 208 patients studied, 75 patients had D-dimer levels above the normal range on admission (>0.5 μg/mL; high D-dimer group) while 133 had normal levels (≤0.5 μg/mL; low D-dimer group). The primary outcome was myocardial infarct size assessed by CMR. Secondary outcomes included area at risk (AAR), microvascular obstruction (MVO) area, and myocardial salvage index (MSI). RESULTS: In CMR analysis, myocardial infarct size was larger in the high D-dimer group than in the low D-dimer group (22.3% [16.2-30.5] versus 18.8% [10.7-26.7]; p = 0.02). Compared to the low D-dimer group, the high D-dimer group also had a larger AAR (38.1% [31.7-46.9] versus 35.8% [24.2-45.3]; p = 0.04) and a smaller MSI (37.7 [28.2-46.9] versus 47.1 [33.2-57.0]; p = 0.01). In multivariate analysis, high D-dimer levels were significantly associated with larger myocardial infarct (OR 2.59; 95% CI 1.37-4.87; p<0.01) and lower MSI (OR 2.62; 95% CI 1.44-4.78; p<0.01). CONCLUSIONS: In STEMI patients undergoing primary PCI, high D-dimer levels on admission were associated with a larger myocardial infarct size, a greater extent of AAR, and lower MSI, as assessed by CMR data. Elevated initial D-dimer level may be a marker of advanced myocardial injury in patients treated with primary PCI for STEMI.
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Choi et al. (2016) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=208). High D-dimer levels on admission (>0.5 μg/mL) vs. Low D-dimer levels (≤0.5 μg/mL) was evaluated on Larger myocardial infarct (≥20% of left ventricular volume) assessed by CMR (OR 2.59, 95% CI 1.37-4.87, p=<0.01). High D-dimer levels on admission in STEMI patients undergoing primary PCI were significantly associated with a larger myocardial infarct size (OR 2.59) and lower myocardial salvage index.
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