Sarli B, Akpek M, Baktir A O, Sahin O, Saglam H, Arinc H, Odabasi H, Dogan S, Kurtul S, Dogan Y, Kaya M G
Department of Cardiology, Kayseri Education and Research Hospital, 38010, Kayseri, Turkey,
Herz. 2015 May;40(3):507-13. doi: 10.1007/s00059-013-4029-2. Epub 2014 Jan 19.
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.
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.
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.
梗死相关动脉的干预前血栓负荷是冠状动脉疾病中无复流和不良结局的独立预测指标。D - 二聚体在ST段抬高型心肌梗死（STEMI）急性期经皮冠状动脉介入治疗（PCI）中的作用尚未完全阐明。我们旨在研究血清D - 二聚体水平对STEMI患者预后的预测价值。
本研究纳入了266例症状发作后12小时内连续就诊的STEMI患者。根据介入治疗后的心肌梗死溶栓（TIMI）血流分级评分将患者分为两组。介入治疗后TIMI分级为0、1或2定义为无复流（第1组），血管造影成功定义为TIMI 3级血流（第2组）。介入治疗后无复流患者的D - 二聚体水平显著高于介入治疗后TIMI 3级血流患者（686±236μg/ml对418±164μg/ml，p<0.001）。多因素逻辑回归分析显示，D - 二聚体水平是介入治疗后无复流（比值比：1.005；95%可信区间：1.003 - 1.007；p<0.001）和院内主要不良心血管事件（MACE；比值比：1.002；95%可信区间：1.000 - 1.004；p = 0.029）的独立预测指标。受试者工作特征分析得出，预测无复流时D - 二聚体的截断值为549μg/ml，敏感性为８３％，特异性为８１％；预测院内MACE时截断值为544μg/ml，敏感性为69％，特异性为67％。
总之，入院时测得的D - 二聚体水平可能是无复流的独立预测指标，而无复流也是STEMI患者不良结局的预测指标。
