Huang Dong, Gao Wei, Wu Runda, Zhong Xin, Qian Juying, Ge Junbo
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
Int J Cardiol. 2020 Apr 15;305:1-4. doi: 10.1016/j.ijcard.2020.02.010. Epub 2020 Feb 4.
Use of D-dimer for prognostication of patients with ST-segment elevation myocardial infarction (STEMI) remains controversial and undefined among those with angiographically evident thrombus or no-reflow phenomenon.
We retrospectively analyzed consecutive STEMI patients who received primary percutaneous coronary intervention (PCI) at Zhongshan Hospital Fudan University from January 2008 to December 2018. Outcomes were in-hospital major adverse cardiovascular events (MACE: cardiac death, non-fatal acute myocardial infarction, re-vascularization and stroke), peak troponin T and NT-proBNP levels, left ventricular ejection fraction (LVEF) and hospitalization duration.
Among 1165 patients, those with increased (≥0.8 mg/L, n = 224, 19.2%) vs. normal (n = 941, 80.8%) D-dimer level were older; more often women and non-smokers. Increased D-dimer group had similar frequency of AET (58.7% vs. 62.1%, P = .353), more frequently no-reflow phenomenon (13.1% vs. 18.8%, P = .028), higher peak values of troponin T (3.5 [0.9-7.0] vs. 4.5 [1.8-8.7], P = .001) and NT-proBNP (903.3 [532.3-2098.5] vs. 2070.0 [859.1-4378.0], p < .001). In increased D-dimer group, LVEF (53.3 ± 8.3 vs. 48.8 ± 9.8, P < .001) was lower, hospitalization was longer (8.0 ± 4.9 vs. 10.5 ± 6.9 days, P < .001) and risk of developing in-hospital MACE (1.5% vs. 12.1%, P < .001) was greater. D-dimer level was an independent risk factor for MACE (OR 8.408, 95%CI 4.065-17.392, P < .001), including the angiographically evident thrombus (OR 6.939, 95% CI 2.944-16.355, P < .001) and the no-reflow (OR 8.114, 95% CI 1.598-41.196, P = .012) subgroups.
Increased D-dimer level was an independent risk factor for in-hospital MACE in STEMI patients undergoing primary PCI, including those with angiographically evident thrombus and no-reflow phenomenon. D-dimer was not associated to no-reflow phenomenon in STEMI patients.
在ST段抬高型心肌梗死（STEMI）患者中，使用D - 二聚体进行预后评估在血管造影显示有血栓或存在无复流现象的患者中仍存在争议且尚未明确。
我们回顾性分析了2008年1月至2018年12月在复旦大学附属中山医院接受直接经皮冠状动脉介入治疗（PCI）的连续性STEMI患者。观察指标包括住院期间主要不良心血管事件（MACE：心源性死亡、非致死性急性心肌梗死、血管再通和卒中）、肌钙蛋白T峰值和NT - proBNP水平、左心室射血分数（LVEF）以及住院时间。
在1165例患者中，D - 二聚体水平升高（≥0.8mg/L）组（n = 224，19.2%）与正常组（n = 941，80.8%）相比，年龄更大；女性和非吸烟者更常见。D - 二聚体水平升高组的AET发生率相似（58.7%对62.1%，P = 0.353），无复流现象更常见（13.1%对18.8%，P = 0.028），肌钙蛋白T峰值更高（3.5[0.9 - 7.0]对4.5[1.8 - 8.7]，P = 0.001）以及NT - proBNP更高（903.3[532.3 - 2098.5]对2070.0[859.1 - 4378.0]，P < 0.001）。在D - 二聚体水平升高组中，LVEF更低（53.3±8.3对48.8±9.8，P < 0.001），住院时间更长（8.0±4.9对10.5±6.9天，P < 0.001），发生住院期间MACE的风险更高（1.5%对12.1%，P < 0.001）。D - 二聚体水平是MACE的独立危险因素（OR 8.408，95%CI 4.065 - 17.392，P < 0.001），包括血管造影显示有明显血栓的亚组（OR 6.939，95%CI 2.944 - 16.355，P < 0.001）和无复流亚组（OR 8.114，95%CI 1.598 - 41.196，P = 0.012）。
D - 二聚体水平升高是接受直接PCI的STEMI患者住院期间MACE的独立危险因素，包括血管造影显示有明显血栓和无复流现象的患者。D - 二聚体与STEMI患者的无复流现象无关。
