Key result
Admission D-dimer >0.69 ug/ml was an independent predictor of contrast-induced acute kidney injury (OR 3.37; 95% CI 1.80-6.33; p<0.0001) in patients with STEMI undergoing primary PCI.
Why the study?
Although D-dimer is associated with AMI and renal insufficiency, whether it is an independent risk factor for CI-AKI in patients undergoing pPCI was uncertain.
Does admission D-dimer predict contrast-induced acute kidney injury and long-term mortality in STEMI patients undergoing primary PCI?
Cohort (n=550)
Does 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)
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.
May refine contrast-induced AKI risk prediction in STEMI primary PCI; leaves open prospective validation and clinical utility.
Introduction: 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 (AUCDD=0.729 vs AUCMehran=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 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 a cohort in ST-segment 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) (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; 95% CI 1.80-6.33; p<0.0001) in patients with STEMI undergoing primary PCI.
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