Predictive value of elevated D-dimer in patients undergoing primary angioplasty for ST elevation myocardial infarction

Jiang

et al. 2020

Preprint

Background DD was found to be associated with acute myocardial infarction (AMI) and renal insufficiency. However, it is uncertain whether DD is an independent risk factor of CI-AKI in patients undergoing pPCI. Methods We prospectively enrolled 550 consecutive patients with STEMI undergoing pPCI between January 2012 and December 2016. The predictive value of admission DD for CI-AKI was assessed by receiver operating characteristic(ROC) and multivariable logistic regression analysis. CI-AKI was defined as an absolute serum creatinine increase ≥0.3 mg/dl or a relative increase in serum creatinine ≥50% within 48 h of contrast medium exposure. Results Overall, the incidence of CI-AKI was 13.1%. The ROC analysis showed that the cutoff point of DD was 0.69 ug/ml for predicting CI-AKI with a sensitivity of 77.8% and a specificity of 57.3%. The predictive value of DD was similar to the Mehran score for CI-AKI (AUC DD =0.729 vs AUC Mehran =0.722; p =0.8298). Multivariate logistic regression analysis indicated that DD >0.69 ug/ml was an independent predictor of CI-AKI (odds ratio[OR]=3.37,95%CI:1.80-6.33, p <0.0001). Furthermore, DD >0.69 ug/ml was associated with an increased risk of long-term mortality during during a mean follow-up period of 16 months(hazard ratio=3.41, 95%CI:1.4-8.03, p =0.005). Conclusion admission DD >0.69 ug/ml is a significant and independent predictor of CI-AKI and long-term mortality in patients undergoing pPCI.

Section: Discussionmentioning

confidence: 99%

Predictive Value of Admission D-dimer for Contrast-induced Acute Kidney Injury and Poor Outcomes after Primary Percutaneous Coronary Intervention

Lin

Jiang

et al. 2020

Preprint

“…Furthermore, DD was found to be associated with poor outcomes in patients with AMI. Akgul O et al [10] demonstrated that a high admission DD level (>0.72 ug/ml FEU) was a powerful independent predictor of 6-month allcause mortality. Another study of HORIZONS-AMI trial [38] showed admission DD levels were a strong predictor of MACE in patients treated with pPCI within 3 years follow up.Compared with patients with lower DD levels(<0.71 ug/ml), patients wiht higher DD levels(≥0.71 ug/ml) on admission were associated with an adjusted hazard ratio of 2.58 for MACE.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, DD had been reported to be a marker for the early diagnosis of ACS presenting with chest pain [8] and acute myocardial infarction (AMI) [9] . Furthermore, DD had been found to be associated with short-, mid-and long-term poor outcomes in patient with AMI [10][11][12] . In addition, as a marker of increased coagulability and fibrinolysis, DD also had been documented to be associated with renal insufficiency, which indicated that DD concentration increased significantly with increasing creatinine levels [13] or decreasing estimated glomerular filtration rate(GFR) [14] .…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of Admission D-dimer for Contrast-induced Acute Kidney Injury and Poor Outcomes after Primary Percutaneous Coronary Intervention

Lin

Jiang

et al. 2019

Preprint

Background DD was found to be associated with acute myocardial infarction (AMI) and renal insufficiency. However, it is uncertain whether DD is an independent risk factor of CI-AKI in patients undergoing pPCI.Methods We prospectively enrolled 550 consecutive patients with STEMI undergoing pPCI between January 2012 and December 2016. The predictive value of admission DD for CI-AKI was assessed by receiver operating characteristic(ROC) and multivariable logistic regression analysis. CI-AKI was defined as an absolute serum creatinine increase ≥0.3 mg/dl or a relative increase in serum creatinine ≥50% within 48 h of contrast medium exposure.Results Overall, the incidence of CI-AKI was 13.1%. The ROC analysis showed that the cutoff point of DD was 0.69 ug/ml for predicting CI-AKI with a sensitivity of 77.8% and a specificity of 57.3%. The predictive value of DD was similar to the Mehran score for CI-AKI (AUC DD =0.729 vs AUC Mehran =0.722; p =0.8298). Multivariate logistic regression analysis indicated that DD >0.69 ug/ml was an independent predictor of CI-AKI (odds ratio[OR]=3.37,95%CI:1.80-6.33, p <0.0001). Furthermore, DD >0.69 ug/ml was associated with an increased risk of long-term mortality during during a mean follow-up period of 16 months(hazard ratio=3.41, 95%CI:1.4-8.03, p =0.005).Conclusion admission DD >0.69 ug/ml is a significant and independent predictor of CI-AKI and long-term mortality in patients undergoing pPCI.

“…Increasing evidences show that cys C is associated with cardiovascular risk and mortality in patients with non‐ST elevated acute coronary syndrome and is the most powerful predictor for major adverse cardiac events in patients with acute coronary syndrome . Akgul et al have investigated the predictive value of elevated cys C in STEMI patients undergoing primary PCI, and have found that the elevated cys C level, rather than the creatinine level nor eGFR, was an independent predictor of increased in‐hospital and 1‐month cardiac mortality in patients with STEMI undergoing primary PCI . Tang et al have found that elevated cys C levels at admission were independently associated with impaired myocardial perfusion, poor cardiac functional recovery, and development of congestive heart failure in these patients .…”

Section: Discussionmentioning

confidence: 99%

High cystatin C levels predict long‐term mortality in patients with ST‐segment elevation myocardial infarction undergoing late percutaneous coronary intervention: A retrospective study

Fan

Men

et al. 2019

Clinical Cardiology

Objectives Late percutaneous coronary intervention (PCI) in patients with ST‐segment elevation myocardial infarction (STEMI), defined as time of PCI > 7 days from symptom onset, is a common practice with clinical benefits. This study aimed to evaluate the predictive value of admission cystatin C (cys C) level on long‐term mortality in STEMI patients receiving late PCI. Methods Medical records of STEMI patients who were hospitalized between 2009 and 2011 from eight PCI‐capable hospitals in Northwest China were retrospectively analyzed. Cys C level ≥ 1.105 mg/L was considered as the best predictor of long‐term mortality based on the receiver‐operating characteristic analysis. Patients were followed up by phone or face‐to‐face interviews, and the long‐term mortality was obtained by reviewing medical records. Results The final analysis included 716 STEMI patients who received late PCI and had available cys C levels prior to PCI, and 524 were assigned into the high cys C group and 192 the low cys C group. Patients were followed up for an average length of 40.37 months. Compared with the low cys C group, the high cys C group had a higher long‐term all‐cause mortality (10.4% vs 2.9%, P < 0.001) and a higher cardiac mortality (6.8% vs 2.1%, P = 0.004). Multivariate Cox regression analysis showed that high cys C level was an independent predictor for both long‐term all‐cause mortality and cardiac mortality. Conclusions High cys C level at admission is an independent predictor of long‐term mortality in STEMI patients undergoing late PCI.