Key result
High D-dimer levels (≥ 1150 ng/mL) were associated with a nearly two-fold increased risk of all-cause death (HR 1.98) compared to low levels (< 420 ng/mL) in ACS patients treated by PCI.
Why the study?
Associations between D-dimer and outcomes in patients with acute coronary syndromes remain controversial.
Does D-dimer level predict all-cause death in patients with acute coronary syndrome treated by percutaneous coronary intervention?
Cohort (n=3,972)
No
Does D-dimer level predict all-cause death in patients with acute coronary syndrome treated by percutaneous coronary intervention?
Hazard Ratio: 1.98 (95% CI 1.36–2.89)
Absolute Event Rate: 12.6% vs 1.2%
p-value: p=<0.001
Elevated D-dimer levels independently predict all-cause mortality and improve risk stratification when added to standard clinical risk scores in patients with ACS undergoing PCI.
D-dimer may refine post-PCI risk stratification in ACS; leaves open prospective validation before clinical adoption.
Background Associations between D-dimer and outcomes of patients with acute coronary syndromes (ACS) remain controversial. This study aimed to investigate the prognostic value of D-dimer in ACS patients treated by percutaneous coronary intervention (PCI). Methods In this observational study, 3972 consecutive patients with ACS treated by PCI were retrospectively recruited. The X-tile program was used to determine the optimal D-dimer thresholds for risk stratifications. Cox regression with multiple adjustments was used for outcome analysis. Restricted cubic spline (RCS) analysis was performed to assess the dose-response association between D-dimer and outcomes. The C-index was calculated to evaluate the additional prognostic value of D-dimer when added to clinical risk factors and commonly used clinical risk scores, with internal validations using bootstrapping methods. The primary outcome was all-cause death. Results During a median follow-up of 720 days, 225 deaths occurred. Based on the thresholds generated by X-tile, ACS-PCI patients with median (420–1150 ng/mL, hazard ratio [HR]: 1.58, 95 % confidence interval [CI]: 1.14–2.20, P = 0.007) and high (≥ 1150 ng/mL, HR: 1.98, 95 % CI: 1.36–2.89, P < 0.001) levels of D-dimer showed substantially higher risk of death compared to those with low D-dimer (< 420 ng/mL). RCS analysis depicted a constant relation between D-dimer and various outcomes. The addition of D-dimer levels significantly improved risk predictions for all-cause death when combined with the fully adjusted models (C-index: 0.853 vs. 0.845, P difference = 0.021), the GRACE score (C-index: 0.826 vs. 0.814, P difference = 0.027), and the TIMI score (C-index: 0.804 vs. 0.776, P difference < 0.001). The predicted mortality at the median follow-up (two years) was 1.7 %, 5.2 %, and 10.9 % for patients with low, median, and high D-dimer, respectively, which was well matched with the observed mortality (low D-dimer group: 1.2 %, median D-dimer group: 5.2 %, and high D-dimer group: 12.6 %). Conclusions For ACS patients treated by PCI, D-dimer level was an independent predictor for adverse outcomes, and provided additional prognostic value when combined with clinical risk factors and risk scores. Risk stratifications based on D-dimer was plausible to differentiate ACS-PCI patients with higher risk of death.
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Chen et al. (2021) conducted a cohort in Acute coronary syndrome (ACS) treated by percutaneous coronary intervention (PCI) (n=3,972). High D-dimer level (≥ 1150 ng/mL) vs. Low D-dimer level (< 420 ng/mL) was evaluated on All-cause death (HR 1.98, 95% CI 1.36-2.89, p=<0.001). High D-dimer levels (≥ 1150 ng/mL) were associated with a nearly two-fold increased risk of all-cause death (HR 1.98) compared to low levels (< 420 ng/mL) in ACS patients treated by PCI.
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