Key result
Higher D-dimer linked to ~26% greater cardiovascular event risk in ACS.
Why the study?
Data on the prognostic role of D-dimer in patients with acute coronary syndrome are controversial.
Are elevated D-Dimer levels associated with increased risk of cardiovascular events and no-reflow in patients with acute coronary syndrome?
Meta-Analysis (n=8,616)
Are elevated D-Dimer levels associated with increased risk of cardiovascular events and no-reflow in patients with acute coronary syndrome?
Hazard Ratio: 1.264 (95% CI 1.134–1.409)
Elevated D-Dimer levels in patients with acute coronary syndrome are associated with a higher risk of short- and long-term cardiovascular events and the no-reflow phenomenon, suggesting its potential utility in stratifying residual thrombotic risk.
May support residual thrombotic risk stratification in ACS; confirms D-dimer prognostic association in meta-analysis.
Background Data on the prognostic role of D-dimer in patients with acute coronary syndrome (ACS) are controversial. Our aim was to summarize current evidence on the association between D-dimer levels and short/long-term poor prognosis of ACS patients. We also investigated the association between D-Dimer and no-reflow (NR) phenomenon.Methods Systematic review and metanalysis of observational studies including ACS patients and reporting data on D-Dimer levels. PubMed and SCOPUS databases were searched. Data were combined with hazard ratio (HR) and metanalysed. The principal endpoint was a composite of cardiovascular events (CVEs) including myocardial infarction, all-cause and cardiovascular mortality. Results Overall, 32 studies included in the systematic review with 28,869 patients. Of them, 6 studies investigated in-hospital and 26 studies long-term outcomes. Overall, 23 studies showed positive association of high D-Dimer levels with CVEs. D-Dimer levels predicted poor prognosis in all studies reporting in-hospital outcomes. Five studies satisfied inclusion criteria and were included in the metanalysis, with a total of 8,616 patients. Median follow-up was 13.2 months with 626 CVEs. The pooled HR for D-dimer levels and CVEs was 1.264 (95% CI 1.134-1.409). Five out of 7 studies (4,195 STEMI patients) investigating the association between D-Dimer levels and NR showed a positive correlation of D-dimer levels with NR. Conclusions In patients with ACS D-Dimer was associated with higher in-hospital and short/long-term complications. D-Dimer was also higher in patients with NR phenomenon. The use of D-Dimer may help to identify patients with residual thrombotic risk after ACS.Trial registration: the review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews: CRD42021267233.
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Biccirè et al. (2021) conducted a meta-analysis in Acute Coronary Syndrome (n=8,616). High D-Dimer levels vs. Low D-Dimer levels was evaluated on Composite of cardiovascular events (CVEs) including myocardial infarction, all-cause and cardiovascular mortality (HR 1.264, 95% CI 1.134-1.409). Higher D-dimer levels were significantly associated with an increased risk of cardiovascular events in patients with acute coronary syndrome (HR 1.264).
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