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

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          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.

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          Most cited references16

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          2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

          Patrick O'Gara, Frederick Kushner, Deborah D Ascheim … (2013)
          Article 0 comments Cited 861 times – based on 0 reviews     Review now
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            New oral anticoagulants in addition to single or dual antiplatelet therapy after an acute coronary syndrome: a systematic review and meta-analysis

            Jonas Oldgren, Lars Wallentin, John H Alexander … (2013)
            Background Oral anticoagulation in addition to antiplatelet treatment after an acute coronary syndrome might reduce ischaemic events but increase bleeding risk. We performed a meta-analysis to evaluate the efficacy and safety of adding direct thrombin or factor-Xa inhibition by any of the novel oral anticoagulants (apixaban, dabigatran, darexaban, rivaroxaban, and ximelagatran) to single (aspirin) or dual (aspirin and clopidogrel) antiplatelet therapy in this setting. Methods and results All seven published randomized, placebo-controlled phase II and III studies of novel oral anticoagulants in acute coronary syndromes were included. The database consisted of 30 866 patients, 4135 (13.4%) on single, and 26 731 (86.6%) on dual antiplatelet therapy, with a non-ST- or ST-elevation acute coronary syndrome within the last 7–14 days. We defined major adverse cardiovascular events (MACEs) as the composite of all-cause mortality, myocardial infarction, or stroke; and clinically significant bleeding as the composite of major and non-major bleeding requiring medical attention according to the study definitions. When compared with aspirin alone the combination of an oral anticoagulant and aspirin reduced the incidence of MACE [hazard ratio (HR) and 95% confidence interval 0.70; 0.59–0.84], but increased clinically significant bleeding (HR: 1.79; 1.54–2.09). Compared with dual antiplatelet therapy with aspirin and clopidogrel, adding an oral anticoagulant decreased the incidence of MACE modestly (HR: 0.87; 0.80–0.95), but more than doubled the bleeding (HR: 2.34; 2.06–2.66). Heterogeneity between studies was low, and results were similar when restricting the analysis to phase III studies. Conclusion In patients with a recent acute coronary syndrome, the addition of a new oral anticoagulant to antiplatelet therapy results in a modest reduction in cardiovascular events but a substantial increase in bleeding, most pronounced when new oral anticoagulants are combined with dual antiplatelet therapy.
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              D-Dimer Predicts Long-Term Cause-Specific Mortality, Cardiovascular Events, and Cancer in Patients With Stable Coronary Heart Disease

              John Simes, Kristy P Robledo, Harvey White … (2018)
              D-dimer, a degradation product of cross-linked fibrin, is a marker for hypercoagulability and thrombotic events. Moderately elevated levels of D-dimer are associated with the risk of venous and arterial events in patients with vascular disease. We assessed the role of D-dimer levels in predicting long-term vascular outcomes, cause-specific mortality, and new cancers in the LIPID trial (Long-Term Intervention with Pravastatin in Ischaemic Disease) in the context of other risk factors.
              Article 0 comments Cited 53 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Tongtong Yu: workhard31@vip.163.com
                Yundi Jiao: jiaoyundi1987@163.com
                Jia Song: 836214497@qq.com
                Dongxu He: 1570057021@qq.com
                Jiake Wu: wujiake1107@163.com
                Zhijun Sun: sunzhijun@sj-hospital.org
                Zhaoqing Sun:
                ORCID: http://orcid.org/0000-0002-1608-7396
                sunzhaoqing@vip.163.com
                Journal
                Journal ID (nlm-ta): BMC Cardiovasc Disord
                Journal ID (iso-abbrev): BMC Cardiovasc Disord
                Title: BMC Cardiovascular Disorders
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2261
                Publication date (Electronic): 10 November 2019
                Publication date PMC-release: 10 November 2019
                Publication date Collection: 2019
                Volume: 19
                Electronic Location Identifier: 252
                Affiliations
                ISNI 0000 0004 1806 3501, GRID grid.412467.2, Department of Cardiology, , Shengjing Hospital of China Medical University, ; Shenyang, Liaoning People’s Republic of China
                Author information
                http://orcid.org/0000-0002-1608-7396
                Article
                Publisher ID: 1239
                DOI: 10.1186/s12872-019-1239-4
                PMC ID: 6842504
                PubMed ID: 31707974
                SO-VID: 50edb9cf-c525-41c5-8be8-ef06d2bb2d36
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 18 February 2019
                Date accepted : 25 October 2019
                Funding
                Funded by: grants from the Social Development Research Program of Liaoning Province
                Award ID: 2011225020
                Award Recipient :
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: d-dimer,in-hospital mortality,acute coronary syndrome,grace score,percutaneous coronary intervention
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: d-dimer, in-hospital mortality, acute coronary syndrome, grace score, percutaneous coronary intervention

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