Hospital mortality in acute coronary syndrome: adjustment of GRACE score by D-dimer enables a more accurate prediction in a prospective cohort study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome (ACS) (n=5923). Intervention: High D-dimer level (>179 ng/mL) vs. Low D-dimer level (≤88 ng/mL). Primary outcome: In-hospital mortality (OR 3.079, 95% CI 1.079-8.788, p=0.036).

Tongtong Yu; Yundi Jiao; Jia Song; Dongxu He; Jiake Wu; Zhijun Sun; Zhaoqing Sun; Zhaoqing Sun; Zhaoqing Sun

doi:10.1186/s12872-019-1239-4

November 10, 2019BMC Cardiovascular DisordersOpen Access

Hospital mortality in acute coronary syndrome: adjustment of GRACE score by D-dimer enables a more accurate prediction in a prospective cohort study

View Full Paper

Ask AI

Bookmark

Share

Key result

In patients with acute coronary syndrome undergoing percutaneous coronary intervention, high D-dimer levels independently predicted in-hospital mortality (OR 3.079) and significantly improved the prognostic performance of the GRACE score.

Figures

Why the study?

To assess the value of D-dimer and its combination with the GRACE score for predicting in-hospital mortality in patients with ACS undergoing PCI.

Does elevated D-dimer predict in-hospital mortality and improve the prognostic performance of the GRACE score in patients with acute coronary syndrome undergoing percutaneous coronary intervention?

Study Design

Type

Cohort (n=5,923)

Multicenter

No

Structured PICO

Does elevated D-dimer predict in-hospital mortality and improve the prognostic performance of the GRACE score in patients with acute coronary syndrome undergoing percutaneous coronary intervention?

P

Population

5,923 patients with acute coronary syndrome undergoing percutaneous coronary intervention, evaluated for in-hospital mortality.

E

Exposure

High D-dimer level (>179 ng/mL) or D-dimer assessed as a continuous variable on admission

C

Comparator

Low D-dimer (≤88 ng/mL) and Intermediate D-dimer (89-179 ng/mL) groups

O

Outcome

In-hospital mortalityhard clinical

Main Result

Odds Ratio: 3.079 (95% CI 1.079–8.788)

Absolute Event Rate: 1.9% vs 0.5%

p-value: p=0.036

Adding D-dimer levels to the GRACE score significantly improves the prediction of in-hospital mortality in patients with acute coronary syndrome undergoing percutaneous coronary intervention.

Limitations

Single-center, prospective and observational study design makes it difficult to completely adjust for potential confounders and selection bias.
High-sensitivity C-reactive protein, other proinflammatory cytokines, or markers of oxidative stress were not included.
Use of unfractionated heparin or low molecular weight heparin might affect D-dimer levels.
Potential selection bias due to the exclusion of some high-risk patients who used unfractionated heparin or LMWH.
Incomplete data regarding the history of medication treatments that influence coagulation and inflammation, such as statins.
Single-center, prospective and observational study making it hard to completely adjust potential confounders and selection bias
High-sensitivity C-reactive protein, other proinflammatory cytokines, or markers of oxidative stress were not included
Use of unfractionated heparin or low molecular weight heparin might affect D-dimer levels
Some high-risk patients might be excluded because of the use of unfractionated heparin or LMWH, causing potential selection bias
Data about the history of medication treatment that influenced coagulation and inflammatory, such as statin, was not complete

Implication

May refine GRACE-based in-hospital risk stratification in ACS-PCI; hypothesis-generating pending prospective validation.

Abstract

BACKGROUD: To assess the value of D-dimer and its combination with The Global Registry of Acute Coronary Events (GRACE) score in predicting in-hospital mortality in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). METHODS: In 5923 ACS patients undergoing PCI, the role of D-dimer and the added value of D-dimer to GRACE score for predicting in-hospital mortality were tested. RESULTS: After multivariable adjustment, D-dimer could significantly predict in-hospital mortality. Also, it could significantly improve the prognostic performance of GRACE score (C-statistic: z = 2.269, p = 0.023; IDI: 0.016, p = 0.032; NRI: 0.291, p = 0.035). CONCLUSION: In patients with ACS undergoing PCI, D-dimer was an independent predictor of in-hospital death. It could also improve the prognostic performance of GRACE score.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Yu et al. (2019) conducted a cohort in Acute coronary syndrome (ACS) (n=5,923). High D-dimer level (>179 ng/mL) vs. Low D-dimer level (≤88 ng/mL) was evaluated on In-hospital mortality (OR 3.079, 95% CI 1.079-8.788, p=0.036). In patients with acute coronary syndrome undergoing percutaneous coronary intervention, high D-dimer levels independently predicted in-hospital mortality (OR 3.079) and significantly improved the prognostic performance of the GRACE score.

synapsesocial.com/papers/6a900ebae73a4c404fc91703 https://doi.org/10.1186/s12872-019-1239-4

Topics

Percutaneous coronary intervention

View Full Paper

Ask AI

Bookmark

Share

Hospital mortality in acute coronary syndrome: adjustment of GRACE score by D-dimer enables a more accurate prediction in a prospective cohort study

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Hospital mortality in acute coronary syndrome: adjustment of GRACE score by D-dimer enables a more accurate prediction in a prospective cohort study

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

More related papers

More on Percutaneous coronary intervention

More from BMC Cardiovascular Disorders

Topics

Keep reading

More related papers

More on Percutaneous coronary intervention

More from BMC Cardiovascular Disorders