Predictive Value Of D-dimer To Fibrinogen Ratio In Patients After Undergoing Percutaneous Coronary Intervention

BackgroudCoronary artery disease(CAD)is one of the most common cardiovascular diseases in China,and its prevalence and mortality are still on the rise,causing a heavy economic burden on families and society.Over the past few years,percutaneous coronary intervention(PCI),have achieved great success in reducing mortality especially for myocardial infarction.Pedersen et al.reported that although patients with CAD treated with primary PCI have a low risk of cardiac death on the short-term prognosis,the risks of death and in-stent restenosis still gradually increasing over time.In recent years,the role of activation of the coagulation and fibrinolysis system in the pathogenesis and prognosis of CADs have gained wide attention.As a biomarker of fibrin formation and degradation,elevated D-dimer levels have been associated with higher risk of total mortality in patients with different diseases.The LIPID Study have demonstrated that high D-dimer levels are able to predict long-term mortality,cardiovascular events and cancer in stable CAD patients,independently of other risk factors.However,D-dimer concentrations can be influenced in other clinical conditions associated with additional fibrin formation,including old age,malignancies,infections and postoperative states.Fibrinogen,the precursor of fibrin,is a key coagulation factor,which is associated with the thrombotic process and the inflammatory process,and plays a pivotal role in the development of atherosclerosis.Previous studies showed that fibrinogen was not only independently associated with the development of coronary artery disease(CAD),hypertension and stroke,but also an independent predictor of long-term prognosis in patients undergoing PCI.More recently,it has been reported that the D-dimer to fibrinogen ratio(DFR)is a novel predictor for outcomes in pulmonary thromboembolism(PTE),ischaemic stroke and gastrointestinal stromal tumors(GISTs).However,the relation between the DFR and outcomes in CAD patients after PCI has not been investigated.In this study,we enrolled 3,196 patients with CAD who underwent PCI and investigate the relationship between the DFR and clinical outcomes.ObjectiveThis study will investigate the predictive value of D-dimer to fibrinogen ratio(DFR)on admission in the long-term adverse prognosis of patients with coronary heart disease after Percutaneous coronary intervention(PCI)treatment.MethodsIn this study,3196 patients(including 2547 patients with acute coronary syndrome and 791 patients with stable coronary heart disease)admitted to the Department of Cardiology of the First Affiliated Hospital of Zhengzhou University from January 2013 to December 2017 were included in a retrospective cohort study.Clinical data and laboratory indicators of these patients were also collected.Patients were divided into two groups according to the DFR value:the low-level group with DFR<0.52(n=2123)and the high-level group with DFR>0.52(n=1073).The primary endpoints of this study were all-cause mortality(ACM)and Cardiac mortality(CM),and the secondary endpoints were Major adverse Cardiac events(MACE)and Major adverse cardiovascular and cerebrovascular events(MACCE).The mean follow-up time was 37.59±22.24 months,and the end date of follow-up was June 2019.Results1.Several variables were significantly different between the two groups in age,gender,smoking,alcohol drinking,blood urea nitrogen(BUN),creatinine(Cr)and triglyceride(TG)(all P values<0.05).We did not find significant differences in respects of hypertension,diabetes,uric acid(UA),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)(all P values≥0.05).2.For the primary endpoint,we found that the incidence of ACM in the lower DFR group was 51(2.4%),which in the higher DFR group was 71(6.6%),and the difference was significant(P<0.001);the incidence of CM between these two groups also showed significant difference(1.5%vs 4.0%,P<0.001).For the secondary endpoints,the difference was significant in MACCEs(10.8%vs 12.2%,P=0.010),but there were no significant differences in the incidence of MACEs(11.9%vs 11.1%,P=0.246).Significant different variables(P<0.05).3.which were shown in univariate models for each of the predictor variables entered into multivariate Cox regression analysis.The results of multivariate Cox regression analysis showed that compared with the lower group,patients in the higher group had an increased risk of ACM(HR=1.743,95%CI:1.187-2.559,P=0.005)and CM(HR=1.695,95%CI:1.033-2.781,P=0.037)after adjusting the confounding factors of age,gender,smoking,alcohol drinking,BUN,Cr and TG.Furthermore,the Kaplan-Meier analyses showed that elevated DFR was closely related to long-term ACM(log-rank,P<0.001)and CM(log-rank,P<0.001).ConclusionThis study indicates that DFR is an independent and novel predictor of long-term ACM and CM in post-PCI patients with CAD.