Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
J Thromb Thrombolysis. 2014;37(2):155-64. doi: 10.1007/s11239-013-0953-5.
D-dimer is a product of cross linked fibrin degradation and is a measure of the amount of fibrin turnover. As such, D-dimer might be of utility in the prediction of both thrombotic and hemorrhagic events. Therefore, the aim of the present study was to evaluate whether elevated D-dimer levels on admission and at discharge could predict subsequent ischemic and hemorrhagic events in patients with acute myocardial infarction (AMI). D-dimer was measured on admission and at discharge in 461 out of a total of 3,602 patients in the HORIZONS-AMI trial, as part of the formal prespecified biomarker substudy. The predictive value for major adverse cardiovascular events (MACE) and non-CABG major bleeding after 3 year follow up was investigated by stratifying patients in groups of D-dimer level and comparing event rates using Kaplan-Meier and calculating hazard ratios using Cox proportional hazards models. D-dimer levels ≥ 0.71 μg/mL on admission were associated with an adjusted hazard ratio of 2.58 for MACE (p = 0.0014) and 4.61 for major bleeding (p = 0.0018). A discharge D-dimer level ≥ 1.26 μg/mL was associated with a higher risk for MACE by univariate analysis (HR 1.88, p = 0.037), but lost its significance after multivariate adjustment (HR 1.77, p = 0.070). High D-dimer levels on admission were associated with a higher risk of MACE and non-CABG major bleeding in STEMI patients undergoing pPCI.
D-二聚体是交联纤维蛋白降解的产物，是纤维蛋白转化量的衡量标准。因此，D-二聚体可能对预测血栓形成和出血事件都有用。因此，本研究旨在评估急性心肌梗死（AMI）患者入院时和出院时升高的 D-二聚体水平是否可以预测随后的缺血性和出血性事件。在 HORIZONS-AMI 试验中，总共 3602 例患者中有 461 例进行了 D-二聚体的入院和出院测量，这是正式预定的生物标志物亚研究的一部分。通过将患者分层为 D-二聚体水平组，使用 Kaplan-Meier 比较事件发生率，并使用 Cox 比例风险模型计算危险比，来研究 3 年随访后主要不良心血管事件（MACE）和非 CABG 大出血的预测值。入院时 D-二聚体水平≥0.71μg/mL 与 MACE 的调整危险比为 2.58（p=0.0014）和大出血的调整危险比为 4.61（p=0.0018）相关。单变量分析显示，出院时 D-二聚体水平≥1.26μg/mL 与 MACE 的风险增加相关（HR 1.88，p=0.037），但在多变量调整后失去意义（HR 1.77，p=0.070）。在接受 pPCI 的 STEMI 患者中，入院时的高 D-二聚体水平与 MACE 和非 CABG 大出血的风险增加相关。
