Key result
Admission D-dimer >0.69 ug/ml was an independent predictor of contrast-induced acute kidney injury (OR 3.37) and long-term mortality in patients with STEMI undergoing primary percutaneous coronary intervention.
Why the study?
Although D-dimer is associated with acute myocardial infarction and renal insufficiency, whether it is an independent risk factor for CI-AKI in patients undergoing pPCI was uncertain.
Does elevated admission D-dimer predict contrast-induced acute kidney injury and long-term mortality in STEMI patients undergoing primary PCI?
Observational (n=550)
No
Does elevated admission D-dimer predict contrast-induced acute kidney injury and long-term mortality in STEMI patients undergoing primary PCI?
Odds Ratio: 3.37 (95% CI 1.8–6.33)
Absolute Event Rate: 23% vs 5.2%
p-value: p=<0.0001
Admission D-dimer >0.69 ug/ml is a significant independent predictor of contrast-induced acute kidney injury and long-term mortality in STEMI patients undergoing primary PCI.
Background DD was found to be associated with acute myocardial infarction (AMI) and renal insufficiency. However, it is uncertain whether DD is an independent risk factor of CI-AKI in patients undergoing pPCI. Methods We prospectively enrolled 550 consecutive patients with STEMI undergoing pPCI between January 2012 and December 2016. The predictive value of admission DD for CI-AKI was assessed by receiver operating characteristic(ROC) and multivariable logistic regression analysis. CI-AKI was defined as an absolute serum creatinine increase ≥0.3 mg/dl or a relative increase in serum creatinine ≥50% within 48 h of contrast medium exposure. Results Overall, the incidence of CI-AKI was 13.1%. The ROC analysis showed that the cutoff point of DD was 0.69 ug/ml for predicting CI-AKI with a sensitivity of 77.8% and a specificity of 57.3%. The predictive value of DD was similar to the Mehran score for CI-AKI (AUC DD =0.729 vs AUC Mehran =0.722; p =0.8298). Multivariate logistic regression analysis indicated that DD >0.69 ug/ml was an independent predictor of CI-AKI (odds ratio[OR]=3.37,95%CI:1.80-6.33, p <0.0001). Furthermore, DD >0.69 ug/ml was associated with an increased risk of long-term mortality during during a mean follow-up period of 16 months(hazard ratio=3.41, 95%CI:1.4-8.03, p =0.005). Conclusion admission DD >0.69 ug/ml is a significant and independent predictor of CI-AKI and long-term mortality in patients undergoing pPCI.
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Lin et al. (2020) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=550). Admission D-dimer > 0.69 ug/ml vs. Admission D-dimer ≤ 0.69 ug/ml was evaluated on Contrast-induced acute kidney injury (CI-AKI) within 48h of contrast medium exposure (OR 3.37, 95% CI 1.80-6.33, p=<0.0001). Admission D-dimer >0.69 ug/ml was an independent predictor of contrast-induced acute kidney injury (OR 3.37) and long-term mortality in patients with STEMI undergoing primary percutaneous coronary intervention.
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