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      Prognostic Value of D-dimer in patients with acute coronary syndrome treated by percutaneous coronary intervention: a retrospective cohort study

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          Abstract

          Background

          Associations between D-dimer and outcomes of patients with acute coronary syndromes (ACS) remain controversial. This study aimed to investigate the prognostic value of D-dimer in ACS patients treated by percutaneous coronary intervention (PCI).

          Methods

          In this observational study, 3972 consecutive patients with ACS treated by PCI were retrospectively recruited. The X-tile program was used to determine the optimal D-dimer thresholds for risk stratifications. Cox regression with multiple adjustments was used for outcome analysis. Restricted cubic spline (RCS) analysis was performed to assess the dose-response association between D-dimer and outcomes. The C-index was calculated to evaluate the additional prognostic value of D-dimer when added to clinical risk factors and commonly used clinical risk scores, with internal validations using bootstrapping methods. The primary outcome was all-cause death.

          Results

          During a median follow-up of 720 days, 225 deaths occurred. Based on the thresholds generated by X-tile, ACS-PCI patients with median (420–1150 ng/mL, hazard ratio [HR]: 1.58, 95 % confidence interval [CI]: 1.14–2.20, P = 0.007) and high (≥ 1150 ng/mL, HR: 1.98, 95 % CI: 1.36–2.89, P < 0.001) levels of D-dimer showed substantially higher risk of death compared to those with low D-dimer (< 420 ng/mL). RCS analysis depicted a constant relation between D-dimer and various outcomes. The addition of D-dimer levels significantly improved risk predictions for all-cause death when combined with the fully adjusted models (C-index: 0.853 vs. 0.845, P difference = 0.021), the GRACE score (C-index: 0.826 vs. 0.814, P difference = 0.027), and the TIMI score (C-index: 0.804 vs. 0.776, P difference < 0.001). The predicted mortality at the median follow-up (two years) was 1.7 %, 5.2 %, and 10.9 % for patients with low, median, and high D-dimer, respectively, which was well matched with the observed mortality (low D-dimer group: 1.2 %, median D-dimer group: 5.2 %, and high D-dimer group: 12.6 %).

          Conclusions

          For ACS patients treated by PCI, D-dimer level was an independent predictor for adverse outcomes, and provided additional prognostic value when combined with clinical risk factors and risk scores. Risk stratifications based on D-dimer was plausible to differentiate ACS-PCI patients with higher risk of death.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12959-021-00281-y.

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          Most cited references37

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          2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

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            2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC).

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              Fourth universal definition of myocardial infarction (2018)

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                Author and article information

                Contributors
                hbyanfuwai2018@163.com , hbyanfuwai@aliyun.com
                Journal
                Thromb J
                Thromb J
                Thrombosis Journal
                BioMed Central (London )
                1477-9560
                7 May 2021
                7 May 2021
                2021
                : 19
                : 30
                Affiliations
                [1 ]Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
                [2 ]GRID grid.506261.6, ISNI 0000 0001 0706 7839, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, , Chinese Academy of Medical Sciences, ; 167 Beilishi Rd, Xicheng District, 100037 Beijing, China
                [3 ]GRID grid.12955.3a, ISNI 0000 0001 2264 7233, Xiamen Cardiovascular Hospital, , Xiamen University, ; Xiamen, China
                [4 ]GRID grid.415954.8, ISNI 0000 0004 1771 3349, China-Japan Friendship Hospital, ; Beijing, China
                Author information
                http://orcid.org/0000-0002-2031-6438
                Article
                281
                10.1186/s12959-021-00281-y
                8106213
                33962644
                6a8c3263-d805-418e-a142-f6d20830ab0c
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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 in a credit line to the data.

                History
                : 21 January 2021
                : 14 April 2021
                Funding
                Funded by: Chinese Academy of Medical Sciences
                Award ID: 2016-I2M-1-009
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81970308
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100012151, Sanming Project of Medicine in Shenzhen;
                Award ID: SZSM201911017
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2021

                Cardiovascular Medicine
                d-dimer,acute coronary syndromes,percutaneous coronary intervention,prognosis,risk stratifications

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