Jia Sida, Yuan Deshan, Song Ying, Xu Jingjing, Wang Peizhi, Chen Yan, Zhang Ce, Gao Runlin, Zhao Xueyan, Yuan Jinqing
National Clinical Research Center for Cardiovascular Diseases, Fuwai hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Catheter Cardiovasc Interv. 2025 Jul;106(1):144-152. doi: 10.1002/ccd.31526. Epub 2025 Apr 7.
Guideline-recommended PARIS thrombotic risk score predicts coronary thrombosis events (CTE) in Acute Coronary Syndrome (ACS) patients undergoing Percutaneous Coronary Intervention. We aim to evaluate whether D-dimer, a thrombotic biomarker, can predict long-term adverse events and improve the prognostic value of PARIS score.
This is a post-hoc analysis on a prospective cohort of 10,724 Chinese patients undergoing PCI. Patients who presented as ACS were included and stratified according to baseline D-dimer level (cutoff 0.28 µg/mL). The primary endpoint is all-cause death. Secondary endpoints are cardiac death and CTE. A total of 5139 ACS patients with PCI were analyzed, 2735 patients had D-dimer ≥ 0.28 µg/mL, while 2404 patients had D-dimer < 0.28 µg/mL. After adjusting for confounders, patients with higher D-dimer had significantly higher risk of 5-year all-cause death (HR = 1.951, 95% CI: 1.366-2.787) and cardiac death (HR = 2.513, 95% CI: 1.574-4.012), whilst a trend toward higher risk of 5-year CTE (HR = 1.285, 95% CI: 0.956-1.729) was observed. Compared with PARIS score alone, adding D-dimer to the model increased the area under the receiver operating characteristic curve on 5-year all-cause death (0.663-0.701, p = 0.006) and cardiac death (0.652-0.699, p = 0.015), both with significant net reclassification improvement (p < 0.001).
In our cohort of ACS patients undergoing PCI, D-dimer independently predicts long-term all-cause death and cardiac death, and improves the predictive value of PARIS score over 5-year all-cause death and cardiac death.
指南推荐的PARIS血栓形成风险评分可预测接受经皮冠状动脉介入治疗的急性冠状动脉综合征（ACS）患者的冠状动脉血栓形成事件（CTE）。我们旨在评估血栓形成生物标志物D-二聚体是否能预测长期不良事件，并提高PARIS评分的预后价值。
这是一项对10724例接受PCI的中国患者的前瞻性队列进行的事后分析。纳入表现为ACS的患者，并根据基线D-二聚体水平（临界值0.28µg/mL）进行分层。主要终点是全因死亡。次要终点是心源性死亡和CTE。共分析了5139例接受PCI的ACS患者，2735例患者的D-二聚体≥0.28µg/mL，而2404例患者的D-二聚体<0.28µg/mL。在调整混杂因素后，D-二聚体水平较高的患者5年全因死亡风险（HR = 1.951，95%CI：1.366 - 2.787）和心源性死亡风险（HR = 2.513，95%CI：1.574 - 4.012）显著更高，同时观察到5年CTE风险有升高趋势（HR = 1.285，95%CI：0.956 - 1.729）。与单独使用PARIS评分相比，在模型中加入D-二聚体可提高5年全因死亡（0.663 - 0.701，p = 0.006）和心源性死亡（0.652 - 0.699，p = 0.015）的受试者工作特征曲线下面积，两者均有显著的净重新分类改善（p < 0.001）。
在我们接受PCI的ACS患者队列中，D-二聚体可独立预测长期全因死亡和心源性死亡，并提高PARIS评分对5年全因死亡和心源性死亡的预测价值。
