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September 5, 2026BMC Cardiovascular DisordersOpen Access

Admission D-dimer is associated with subsequent cardiac rupture after acute myocardial infarction: a frequency-matched case-control study

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Why the study?

Cardiac rupture is a rare and frequently fatal mechanical complication of AMI, motivating the examination of whether admission hemostatic markers are associated with subsequent in-hospital rupture.

Does admission D-dimer predict subsequent cardiac rupture in patients with acute myocardial infarction?

Population

71 AMI patients with cardiac rupture and 186 frequency-matched controls from 8,132 admissions

Comparison

Admission D-dimer and hemostatic markers in cases with subsequent cardiac rupture vs matched controls

Design

Retrospective single-center frequency-matched case-control study

Follow-up

During hospitalization

Key result

Each doubling of admission D-dimer was independently associated with higher odds of subsequently diagnosed cardiac rupture after acute myocardial infarction (adjusted OR 1.60, 95% CI 1.23-2.09).

Authors

DZDan ZhangCHChaojie HuangLZLitao Zhang

Discussion

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Overview

May inform post-MI rupture risk stratification; hypothesis-generating and requires prospective validation before clinical use.

Key Points

  • To determine whether baseline levels of hemostatic markers, particularly D-dimer, measured at initial hospital admission are associated with subsequent in-hospital cardiac rupture following acute myocardial infarction.
  • Conducted a retrospective, single-center, frequency-matched case-control study analyzing 8,132 acute myocardial infarction admissions between June 2020 and December 2025 (71 cardiac rupture cases, 186 matched controls).
  • Analyzed admission blood samples taken prior to rupture confirmation and fitted multivariable logistic regression models adjusting for age, sex, Killip class III–IV, STEMI status, and onset-to-door time.
  • Standalone admission D-dimer achieved the highest discrimination among evaluated markers with an area under the ROC curve of 0.820 (95% CI, 0.755–0.877).
  • Each doubling of admission D-dimer was independently associated with higher odds of subsequent cardiac rupture (adjusted OR 1.60, 95% CI 1.23–2.09; P = 0.0005), increasing model C-statistic from 0.9238 to 0.9362.
  • The association persisted across sensitivity analyses, including when excluding ruptures that occurred within the first 24 hours of arrival (39 events; adjusted OR 1.37 per doubling, 95% CI 1.02–1.83).

Study Design

Type

Case-Control (n=257)

Multicenter

No

Structured PICO

Does admission D-dimer predict subsequent cardiac rupture in patients with acute myocardial infarction?

P
Population
257 adults with acute myocardial infarction, including 71 who subsequently developed cardiac rupture and 186 frequency-matched controls, evaluated during their index hospitalization.
E
Exposure
Admission D-dimer level (and other coagulation-fibrinolysis markers)
C
Comparator
Lower D-dimer levels / controls without cardiac rupture
O
Outcome
Newly developed cardiac rupture (CR) after index blood sampling during hospitalizationhard clinical

Main Result

Odds Ratio: 1.6 (95% CI 1.23–2.09)

p-value: p=0.0005

Higher admission D-dimer levels are independently associated with subsequently diagnosed cardiac rupture in patients with acute myocardial infarction, though its incremental discriminative value is modest.

Limitations

  • Retrospective single-center case-control design vulnerable to selection and spectrum bias
  • D-dimer was selectively unmeasured more often in cases than controls
  • Admission-to-rupture interval could be resolved only to the day, so evolving subclinical rupture cannot be excluded
  • Onset-to-door time was markedly imbalanced
  • Pre-treatment sampling could not be verified for individual patients
  • Lack of external validation and established clinical utility
  • Retrospective, single-center design
  • Cannot fully distinguish a prognostic marker from an epiphenomenon of an advanced infarct
  • Cases consist overwhelmingly of delayed presenters, so results cannot be generalized to early presenters
  • CR ascertainment was not performed by a separate blinded adjudication committee
  • Small sample size with concern for sparse-data bias

Cite This Study

Zhang et al. (2026) conducted a case-control in Acute myocardial infarction (n=257). Admission D-dimer vs. Lower D-dimer levels was evaluated on Subsequently diagnosed cardiac rupture (OR 1.60, 95% CI 1.23-2.09, p=0.0005). Each doubling of admission D-dimer was independently associated with higher odds of subsequently diagnosed cardiac rupture after acute myocardial infarction (adjusted OR 1.60, 95% CI 1.23-2.09).

synapsesocial.com/papers/6a9bd3a66b95aff0620eadb9https://doi.org/10.1186/s12872-026-06564-4
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