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Impact of D-dimer level on postinterventional coronary flow and in-hospital MACE in ST-segment elevation myocardial infarction

Einfluss des D-Dimer-Spiegels auf den postinterventionellen Koronarfluss und MACE während des stationären Aufenthalts bei ST-Strecken-Hebungs-Infarkt

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Abstract

Objective

Preintervention thrombus burden in the infarct-related artery is an independent predictor of no-reflow and adverse outcomes in coronary artery disease. The role of D-dimers in the acute phase of ST-elevated myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) has not been fully elucidated. We aimed to investigate the predictive value of serum D-dimer levels on the outcome of patients with STEMI.

Methods and results

A total of 266 consecutive patients presenting with STEMI within the first 12 h of symptom onset were included in this study. Patients were divided into two groups based on the postinterventional Thrombolysis In Myocardial Infarction (TIMI) flow grade score. Postinterventional TIMI grades of 0, 1, or 2 were defined as no-reflow (group 1) and angiographic success was defined as TIMI 3 flow (group 2). D-dimer levels were significantly higher in patients with postinterventional no-reflow than in patients with postinterventional TIMI grade 3 flow (686 ± 236 μg/ml–418 ± 164 μg/ml, p < 0.001). Multivariate logistic regression analysis showed that D-dimer level was an independent predictor of postinterventional no-reflow (OR: 1.005; 95 % CI: 1.003–1.007; p < 0.001) and in-hospital major adverse cardiovascular events (MACE; OR: 1.002; 95 % CI: 1.000–1.004; p = 0.029). Receiver operator characteristics analysis provided a cut-off value of 549 μg/ml for D-dimer for predicting no-reflow with an 83 % sensitivity and an 81 % specificity, and 544 μg/ml for predicting in-hospital MACE with a 69 % sensitivity and a 67 % specificity.

Conclusion

In conclusion, D-dimer levels measured on admission may be an independent predictor of no-reflow, which is also a predictor of adverse outcomes in patients with STEMI.

Zusammenfassung

Ziel

Die prävinterventionelle Thrombuslast in der vom Infarkt betroffenen Arterie stellt einen unabhängigen Prädiktor des No-Reflow-Phänomens und ungünstiger Ereignisse bei koronarer Herzkrankheit dar. Die Rolle des D-Dimers in der akuten Phase des ST-Strecken-Hebungs-Infarkts (STEMI) bei primärer perkutaner Koronarintervention (PCI) ist noch nicht vollständig geklärt. Ziel der Studie war es, den prädiktiven Wert der D-Dimer-Serumspiegel für den Verlauf bei Patienten mit STEMI zu untersuchen.

Methoden und Ergebnisse

Insgesamt wurden 266 Patienten mit STEMI, die sich innerhalb der ersten 12 h nach Beginn der Symptome vorstellten, konsekutiv in die Studie aufgenommen. Die Patienten wurden gemäß ihrem postinterventionellen Grad des Blutflusses nach TIMI („thrombolysis in myocardial infarction“) in 2 Gruppen aufgeteilt. Ein postinterventioneller TIMI-Grad von 0, 1 oder 2 wurde als No-Reflow-Phänomen (Gruppe 1) und ein angiographischer Erfolg als TIMI-Fluss von 3 definiert (Gruppe 2). Bei Patienten mit postinterventionellem No-Reflow-Phänomen waren die D-Dimer-Werte signifikant höher als bei Patienten mit postinterventionellem Fluss von TIMI-Grad 3 (686 ± 236 μg/ml–418 ± 164 μg/ml; p < 0,001). Die multivariate logistische Regressionsanalyse ergab, dass der D-Dimer-Spiegel ein unabhängiger Prädiktor für ein postinterventionelles No-Reflow-Phänomen (OR: 1,005; 95%-KI: 1,003–1,007; p < 0,001) und für größere unerwünschte kardiovaskuläre Ereignisse („major adverse cardiovascular events“, MACE) während des stationären Aufenthalts (OR: 1,002; 95%-KI: 1,000–1,004; p = 0,029) war. Nach der Receiver-operating-characteristics-Analyse ergab sich ein D-Dimer-Grenzwert von 549 μg/ml, um ein No-Reflow-Phänomen mit einer Sensitivität von 83 % und einer Spezifität von 81 % vorherzusagen, und ein D-Dimer-Grenzwert von 544 μg/ml, um MACE während des stationären Aufenthalts mit einer Sensitivität von 69 % und einer Spezifität von 67 % vorherzusagen.

Schlussfolgerung

Fazit ist, dass der bei Aufnahme bestimmte D-Dimer-Spiegel möglicherweise ein unabhängiger Prädiktor für ein No-Reflow-Phänomen ist, welches auch einen Prädiktor für unerwünschte Ereignisse bei Patienten mit STEMI darstellt.

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Compliance with ethical guidelines

Conflict of interest. B. Sarli, M. Akpek, A.O. Baktir, O. Sahin, H. Saglam, H. Arinc, H, Odabasi, S. Dogan, S. Kurtul, Y. Dogan, and M.G. Kaya state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Authors and Affiliations

  1. Department of Cardiology, Kayseri Education and Research Hospital, 38010, Kayseri, Turkey

    B. Sarli MD, M. Akpek, A.O. Baktir, O. Sahin, H. Saglam, H. Arinc, H. Odabasi, S. Dogan, S. Kurtul & Y. Dogan

  2. Department of Cardiology, Erciyes University School of Medicine Kayseri, Kayseri, Turkey

    M.G. Kaya

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Correspondence to B. Sarli MD.

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Sarli, B., Akpek, M., Baktir, A. et al. Impact of D-dimer level on postinterventional coronary flow and in-hospital MACE in ST-segment elevation myocardial infarction. Herz 40, 507–513 (2015). https://doi.org/10.1007/s00059-013-4029-2

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