Key result
High D-dimer levels defined by age-adjusted thresholds independently predicted all-cause death in MI patients treated by PCI (HR 1.67; 95% CI 1.23-2.27; P=0.001).
Why the study?
The association between D-dimer and outcomes of patients with myocardial infarction remains controversial, leading this study to investigate the prognostic value of age-adjusted D-dimer in those treated by PCI.
Does a high D-dimer level defined by age-adjusted thresholds predict all-cause death in patients with MI treated by PCI?
Observational (n=3,614)
Does a high D-dimer level defined by age-adjusted thresholds predict all-cause death in patients with MI treated by PCI?
Hazard Ratio: 1.67 (95% CI 1.23–2.27)
p-value: p=0.001
Age-adjusted D-dimer thresholds provide independent prognostic value for all-cause mortality in patients with MI undergoing PCI, improving risk stratification beyond established clinical risk factors and the GRACE score.
Age-adjusted D-dimer may refine post-PCI MI risk stratification; leaves open prospective validation before clinical adoption.
Introduction The association between D-dimer and outcomes of patients with myocardial infarction (MI) remains controversial. Using age-adjusted D-dimer cutoff thresholds significantly improves the accuracy of diagnosis for thrombotic diseases. This study aimed to investigate the prognostic value of age-adjusted D-dimer in MI patients treated by percutaneous coronary intervention (PCI). Methods In this observational study, 3614 consecutive patients with MI treated by PCI were retrospectively recruited. The baseline age-adjusted D-dimer threshold was 500 ng/mL, and was calculated as age × 10 in patients older than 50 years. Cox regression was used for outcome analysis. The primary outcome was all-cause death. Discrimination and reclassification were calculated to assess the additional prognostic value of D-dimer when combined with established clinical risk factors and the Global Registry of Acute Coronary Events (GRACE) risk score. Results During a median follow-up of 652 days, a total of 194 deaths occurred. High D-dimer level, as defined by age-adjusted thresholds, was an independent predictor for all-cause death (hazard ratio:1.67, 95% confidence interval: 1.23–2.27, P=0.001). Addition of D-dimer level (high or low) significantly improved risk classification for death when combined with established clinical risk factors (net reclassification index [NRI]: 0.601, P<0.001; integrated discrimination improvement [IDI]: 0.011, P=0.046) and GRACE score (NRI: 0.618, P<0.001; IDI: 0.015, P=0.011). Conclusions In patients with MI treated by PCI, D-dimer elevation defined by age-adjusted thresholds was an independent predictor for adverse outcomes, and provided additional prognostic value when combined with clinical risk factors and GRACE score. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences
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Chen et al. (2020) conducted an observational in Myocardial infarction treated by percutaneous coronary intervention (n=3,614). High D-dimer level (age-adjusted thresholds) vs. Low D-dimer level was evaluated on All-cause death (HR 1.67, 95% CI 1.23-2.27, p=0.001). High D-dimer levels defined by age-adjusted thresholds independently predicted all-cause death in MI patients treated by PCI (HR 1.67; 95% CI 1.23-2.27; P=0.001).
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