D-二聚体作为预测经皮冠状动脉介入治疗后2年死亡率的血栓生物标志物。
D-dimer as a thrombus biomarker for predicting 2-year mortality after percutaneous coronary intervention.
作者信息
Zhao Xueyan, Li Jianxin, Tang Xiaofang, Jiang Lin, Chen Jue, Qiao Shubin, Yang Yuejin, Gao Runlin, Xu Bo, Yuan Jinqing
机构信息
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China.
出版信息
Ther Adv Chronic Dis. 2020 Mar 16;11:2040622320904302. doi: 10.1177/2040622320904302. eCollection 2020.
BACKGROUND
D-dimer has predictive value for mortality in some diseases. This study aimed to evaluate the correlation between D-dimer and mortality in patients undergoing percutaneous coronary intervention (PCI).
METHODS
We examined 10,724 consecutive patients who underwent PCI between January 2013 and December 2013. The primary endpoint was all-cause mortality, and the secondary endpoint was cardiac mortality. Patients were divided according to the median D-dimer level of 0.28 μg/ml. Multivariable model were including age, sex, and risk factors after stepwise selection.
RESULTS
After a 2-year follow up, 8565 patients with D-dimer data were analyzed. There were 116 (1.35%) all-cause deaths and 64 (0.75%) cardiac deaths. D-dimer levels were significantly higher in the all-cause mortality group [0.42 (0.29, 0.68) μg/ml] and cardiac mortality group [0.48 (0.30, 0.81) μg/ml] than in the survival group [0.28 (0.20, 0.41) μg/ml] (both < 0.001). Multivariate-adjusted Cox hazard analysis showed that high D-dimer levels (⩾0.28 μg/ml) were significantly associated with all-cause mortality in the total population [hazard ratio (HR): 2.35, 95% confidence interval (CI): 1.44-3.84, = 0.001], acute coronary syndrome (ACS) subgroup (HR: 1.91, 95% CI: 1.08-3.38, = 0.027), and stable coronary artery disease (SCAD) subgroup (HR: 3.82, 95% CI: 1.45-10.10, = 0.007). High D-dimer levels were significantly associated with cardiac mortality in the total population (HR: 3.44, 95% CI: 1.61-7.36, = 0.001) and the ACS subgroup (HR: 3.33, 95% CI: 1.38-8.03, = 0.007), but not in the SCAD subgroup (HR: 3.68, 95% CI: 0.80-16.91, = 0.094).
CONCLUSIONS
D-dimer levels are independently associated with 2-year all-cause mortality and cardiac mortality in patients undergoing PCI.
背景
D - 二聚体在某些疾病中对死亡率具有预测价值。本研究旨在评估接受经皮冠状动脉介入治疗（PCI）患者中D - 二聚体与死亡率之间的相关性。
方法
我们检查了2013年1月至2013年12月期间连续接受PCI的10724例患者。主要终点是全因死亡率，次要终点是心脏死亡率。患者根据D - 二聚体水平中位数0.28μg/ml进行分组。多变量模型在逐步选择后纳入了年龄、性别和危险因素。
结果
经过2年随访，对8565例有D - 二聚体数据的患者进行了分析。有116例（1.35%）全因死亡和64例（0.75%）心脏死亡。全因死亡率组[0.42（0.29，0.68）μg/ml]和心脏死亡率组[0.48（0.30，0.81）μg/ml]的D - 二聚体水平显著高于存活组[0.28（0.20，0.41）μg/ml]（均P < 0.001）。多变量校正的Cox风险分析显示，高D - 二聚体水平（≥0.28μg/ml）与总人群的全因死亡率显著相关[风险比（HR）：2.35，95%置信区间（CI）：1.44 - 3.84，P = 0.001]，急性冠状动脉综合征（ACS）亚组（HR：1.91，95%CI：1.08 - 3.38，P = 0.027）和稳定冠状动脉疾病（SCAD）亚组（HR：3.82，95%CI：1.45 - 10.10，P = 0.007）。高D - 二聚体水平与总人群（HR：3.44，95%CI：1.61 - 7.36，P = 0.001）和ACS亚组（HR：3.33，95%CI：1.38 - 8.03，P = 0.007）的心脏死亡率显著相关，但在SCAD亚组中无显著相关性（HR：3.68，95%CI：0.80 - 16.91，P = 0.094）。
结论
D - 二聚体水平与接受PCI患者的2年全因死亡率和心脏死亡率独立相关。
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