Background
Methods
Study cohort
Coronary angiography and PCI procedure
The clinical risk scores
Laboratory measurements
Outcomes and follow‐up
Statistical analysis
Results
Patient cohort and baseline characteristics
Overall (N = 3972) | Survivors (N = 3747) | Non-survivors (N = 225) | P-value | |
---|---|---|---|---|
Age, years | 59.0 ± 11.9 | 58.4 ± 11.8 | 68.4 ± 10.6 | < 0.001 |
Male sex, n (%) | 3132 (78.8) | 2993 (79.9) | 139 (61.8) | < 0.001 |
Diabetes mellitus, n (%) | 1299 (32.7) | 1207 (32.2) | 92 (40.9) | 0.007 |
Hypertension, n (%) | 2429 (61.2) | 2262 (60.4) | 167 (74.2) | < 0.001 |
Peripheral artery diseases, n (%) | 159 (4.0) | 141 (3.8) | 18 (8.0) | 0.002 |
Previous CABG or PCI, n (%) | 583 (14.7) | 548 (14.6) | 35 (15.6) | 0.702 |
STEMI, n (%) | 3467 (87.3) | 3269 (87.2) | 198 (88.0) | 0.741 |
Tumor diseases, n (%) | 81 (2.0) | 71 (1.9) | 10 (4.4) | 0.009 |
Liver diseases, n (%) | 570 (14.8) | 555 (14.8) | 15 (6.7) | 0.001 |
COPD, n (%) | 32 (0.8) | 27 (0.7) | 5 (2.2) | 0.014 |
Hemodynamics | ||||
Heart rate, bpm | 77.4 ± 15.2 | 77.0 ± 14.9 | 83.4 ± 19.7 | < 0.001 |
Systolic blood pressure, mmHg | 124.7 ± 18.3 | 124.8 ± 18.1 | 123.0 ± 21.9 | 0.157 |
EF, % | 53.8 ± 7.6 | 54.1 ± 7.4 | 48.6 ± 9.2 | < 0.001 |
Cardiac arrest, n (%) | 144 (3.6) | 125 (3.3) | 19 (8.4) | < 0.001 |
Laboratory tests | ||||
D-dimer, ng/mL | 330 (220–590) | 330 (220–550) | 600 (320–1240) | < 0.001 |
LDL-C, mmol/L | 2.7 ± 0.9 | 2.7 ± 0.9 | 2.7 ± 0.9 | 0.331 |
hsCRP, mg/L | 7.16 (2.75–12.03) | 7.00 (2.71–11.94) | 11.17 (3.88–13.13) | < 0.001 |
Creatinine, µmoI/L | 82.0 ± 25.1 | 81.0 ± 22.8 | 98.1 ± 47.1 | < 0.001 |
Peak cTnI, ng/mL | 2.50 (0.44–10.80) | 2.48 (0.44–10.62) | 2.97 (0.62–14.01) | 0.093 |
GRACE score | 109.7 ± 27.7 | 107.7 ± 25.9 | 142.0 ± 35.0 | < 0.001 |
TIMI score | 6.3 ± 1.8 | 6.2 ± 1.8 | 8.0 ± 2.0 | < 0.001 |
Findings and details of PCI procedures | ||||
Culprit lesion, n (%) | ||||
Left main artery | 95 (2.4) | 80 (2.1) | 15 (6.7) | < 0.001 |
Left anterior descending artery | 1734 (43.7) | 1632 (43.6) | 102 (45.3) | |
Left circumflex | 610 (15.4) | 592 (15.8) | 18 (8.0) | |
Right coronary artery | 1515 (38.1) | 1429 (38.1) | 86 (38.2) | |
Bypass graft | 18 (0.5) | 14 (0.4) | 4 (1.8) | |
Multi-vessel disease, n (%) | ||||
1-vessel disease | 1002 (25.2) | 966 (25.8) | 36 (16.0) | < 0.001 |
2-vessel disease | 1253 (31.6) | 1201 (32.1) | 52 (23.1) | |
3-vessel disease | 1717 (43.2) | 1580 (42.2) | 137 (60.9) | |
Pre-PCI TIMI 0 flow, n (%) | 2607 (65.6) | 2441 (65.2) | 166 (73.8) | 0.008 |
Post-PCI TIMI 3 flow, n (%) | 3822 (96.2) | 3617 (96.5) | 205 (91.1) | < 0.001 |
D2B time, mins | 128 (95–202) | 128 (95–201) | 125 (90–219) | 0.342 |
Stent placements, n (%) | 3497 (88.0) | 3321 (88.6) | 176 (78.2) | < 0.001 |
Thrombus aspiration, n (%) | 1649 (41.5) | 1561 (41.7) | 88 (39.1) | 0.451 |
IABP, n (%) | 381 (9.6) | 323 (8.6) | 58 (25.8) | < 0.001 |
Glycoprotein IIb/IIIa inhibitor, n (%) | 534 (13.4) | 507 (13.5) | 27 (12.0) | 0.513 |
Complete revascularization before discharge, n (%) | 1731 (43.6) | 1669 (44.5) | 62 (27.6) | < 0.001 |
Medications a | ||||
Aspirin, n (%) | 3930 (98.9) | 3718 (99.2) | 212 (94.2) | < 0.001 |
P2Y12 inhibitors, n (%) | 3936 (99.1) | 3719 (99.3) | 217 (96.4) | < 0.001 |
Statins, n (%) | 3708 (93.4) | 3507 (93.6) | 201 (89.3) | 0.013 |
Associations between D-dimer and outcomes
Unadjusted HR (95 % CI) | P-value | Model 1 HR (95 % CI) | P-value | Model 2 HR (95 % CI) | P-value | Model 3 HR (95 % CI) | P-value | Model 4 HR (95 % CI) | P-value | |
---|---|---|---|---|---|---|---|---|---|---|
All-cause death | ||||||||||
< 420 ng/mL | 1 (reference) | - | 1 (reference) | - | 1 (reference) | - | 1 (reference) | - | 1 (reference) | - |
420–1150 ng/mL | 2.79 (2.04–3.80) | < 0.001 | 1.61 (1.16–2.23) | 0.005 | 1.58 (1.14–2.20) | 0.007 | 1.70 (1.24–2.34) | 0.001 | 1.81 (1.32–2.49) | < 0.001 |
≥ 1150 ng/mL | 5.33 (3.83–7.42) | < 0.001 | 2.09 (1.45–3.02) | < 0.001 | 1.98 (1.36–2.89) | < 0.001 | 2.46 (1.73–3.50) | < 0.001 | 3.33 (2.37–4.68) | < 0.001 |
Log (D-dimer) | 1.68 (1.52–1.86) | < 0.001 | 1.28 (1.13–1.46) | < 0.001 | 1.26 (1.10–1.44) | 0.001 | 1.36 (1.21–1.54) | < 0.001 | 1.51 (1.46–1.67) | < 0.001 |
Cardiac death | ||||||||||
< 420 ng/mL | 1 (reference) | - | 1 (reference) | - | 1 (reference) | - | 1 (reference) | - | 1 (reference) | - |
420–1150 ng/mL | 2.91 (1.97–4.31) | < 0.001 | 1.17 (1.10–2.52) | 0.016 | 1.67 (1.10–2.54) | 0.016 | 1.67 (1.12–2.50) | 0.012 | 1.82 (1.22–2.72) | 0.004 |
≥ 1150 ng/mL | 6.87 (4.61–10.23) | < 0.001 | 2.29 (1.46–3.60) | < 0.001 | 2.15 (1.35–3.42) | 0.001 | 2.76 (1.80–4.24) | < 0.001 | 4.06 (2.69–6.12) | < 0.001 |
Log (D-dimer) | 1.77 (1.57-2.00) | < 0.001 | 1.28 (1.09–1.50) | 0.003 | 1.25 (1.06–1.48) | 0.008 | 1.38 (1.19–1.60) | < 0.001 | 1.58 (1.37–1.82) | < 0.001 |
MACE | ||||||||||
< 420 ng/mL | 1 (reference) | - | 1 (reference) | - | 1 (reference) | - | 1 (reference) | - | 1 (reference) | - |
420–1150 ng/mL | 1.86 (1.49–2.32) | < 0.001 | 1.29 (1.02–1.63) | 0.031 | 1.26 (1.00-1.59) | 0.052 | 1.38 (1.10–1.73) | 0.005 | 1.44 (1.15–1.80) | 0.002 |
≥ 1150 ng/mL | 2.53 (1.94–3.29) | < 0.001 | 1.44 (1.08–1.92) | 0.013 | 1.37 (1.02–1.83) | 0.038 | 1.60 (1.23–2.11) | 0.001 | 1.89 (1.44–2.47) | < 0.001 |
Log (D-dimer) | 1.40 (1.29–1.52) | < 0.001 | 1.15 (1.05–1.27) | 0.004 | 1.14 (1.03–1.26) | 0.013 | 1.21 (1.10–1.33) | < 0.001 | 1.27 (1.16–1.40) | < 0.001 |
Improvement for risk predictions by D-dimer
Risk factors a | All baseline variables | GRACE score | TIMI score | |
---|---|---|---|---|
Original models | ||||
C-index | 0.842 (0.813–0.871) | 0.845 (0.818–0.872) | 0.814 (0.780–0.848) | 0.776 (0.743–0.809) |
Original models + D-dimer (high, median, low) | ||||
C-index | 0.851 (0.823–0.879) | 0.853 (0.826–0.879) | 0.826 (0.794–0.859) | 0.804 (0.773–0.835) |
ΔC-index | 0.009 (0.001–0.016) | 0.008 (0.001–0.014) | 0.012 (0.001–0.024) | 0.028 (0.013–0.043) |
P difference | 0.019 | 0.021 | 0.027 | < 0.001 |
Original models + logarithmic D-dimer | ||||
C-index | 0.849 (0.821–0.877) | 0.851 (0.824–0.878) | 0.825 (0.793–0.857) | 0.800 (0.769–0.831) |
ΔC-index | 0.006 (0.001–0.012) | 0.006 (0.001–0.011) | 0.011 (0.002–0.020) | 0.024 (0.011–0.037) |
P difference | 0.020 | 0.021 | 0.015 | < 0.001 |