The Relationship Between D-Dimer Level And Outcomes Of Acute Non-ST-elevation Myocardial Infarction

?Objective?At present,a large number of clinical and laboratory studies at home and abroad have found that D-dimer is involved in the formation of coronary atherosclerosis.There is a significant correlation between D-dimer level and the presence or absence of coronary heart disease.It also has an effect on the number and severity of coronary artery lesions.At the same time,it also has a certain impact on the prognosis of patients with coronary heart disease.In the clinical classification of coronary heart disease,especially the non-ST segment elevation myocardial infarction coronary artery disease is complex,PCI interventional therapy is difficult,and the prognosis of this population is relatively poor,the incidence of MACE events and readmission rate is on the high side.The purpose of this experimental study was to investigate the relationship between the level of D-dimer and the prognosis of acute non-ST segment elevation myocardial infarction,and to provide some guidance for the evaluation of the condition and prognosis of these patients,so as to assist the clinical treatment of this kind of patients.It helps to improve the prognosis and reduce the incidence and readmission rate of MACE events.?Methods?The data were collected from the Cardiovascular diagnosis and treatment Center of the first affiliated Hospital of Dalian Medical University from January 2010 to December 2015.The follow-up deadline was 12.31 December 2018.The median follow-up time was 46 months.MACE events(recurrent myocardial infarction,cardiogenic death,total cause death,re-revascularization,recurrent angina pectoris and heart failure)were the main end points of the study.According to the different levels of D-dimer in the first admission to hospital,they were divided into group A(D-dimer level ? 120),B group(120 < D-dimer level ? 200),C group).Group D(350< D-dimer level ? 810)was used to evaluate the relationship between D-dimer level and prognosis of patients with acute non-ST segment elevation myocardial infarction.To determine whether the level of D-dimer is a risk factor for the prognosis of acute non-ST segment elevation myocardial infarction and whether the level of D-dimer will affect the survival time of patients with MACE event.? Results ? According to the selection and exclusion criteria,643 patients were selected and followed up by telephone and outpatient follow-up.In this study,586 cases were followed up successfully,57 cases were lost,the rate of loss of visit was8.86%.According to the quartile,there were 152 cases in group A(D-dimer level ?120),143 cases in group B(120 < D-dimer level ? 200)and 146 cases in group C(200 < D-dimer level ? 350).There were 145 cases in group D(350 < D-dimer level ?810).The baseline data showed that there was a positive correlation between age and D-dimer level in the four groups(P ? 0.000 < 0.05,A age: 57.77 ±10.792,95%CI56.04 ? 59.50,P ? 0.000 < 0.05).The age of group B was 59.31 ±11.481,95%CI was57.59 ±61.40,group C was 64.79 ±9.668,95%CI 63.31 was 65.57,and group D was70.49 ±11.324,95% 68.31 ? 72.01).There was a significant correlation between sex,hypertension,diabetes mellitus,smoking and revascularization history and D-dimer level(P = 0.000,0.032,0.008,0.003,respectively).There was no significant correlation between blood lipid and D-dimer level(P = 0.121).A).There was no significant effect on the prognosis of acute non-ST segment elevation cardio-mechanical infarction(P = 0.065 > 0.05).The prognosis of group D was significantly affected by group D(P = 0.029,0.034,0.043 < 0.05).There was no significant effect on the survival time of patients with MACE events in acute non-ST segment elevation cardiac infarction with different D-dimer levels(P ? 0.108 > 0.05).There was no significant difference in survival time between group A and group B(P? 0.854 > 0.05),group A and group C(P = 1.000 > 0.05),group A and group D(P ?0.238 > 0.05).Group B and group C(P ? 0.074 > 0.05),group B and group D(P ?0.849 > 0.05),group C and group D(P < 0.289 > 0.05).According to COX forward stepwise regression method,it was found that age significantly affected the occurrence of MACE events(P ? 0.003 < 0.005),but the age was divided into group A(< 75 years old),B group(? 75 years old).According to the independent sample T test,the P ? 0.330 > 0.05 between the two groups was calculated,which indicated that the survival time of MACE population in group B and group B was not significant for MACE patients with acute non-ST segment elevation myocardial infarction.?Conclusion?1.D-dimer is a risk factor for predicting the prognosis of acute non-ST-segment elevation myocardial infarction.2.For these patients with D-dimer level ? 120ug/L,D-dimer had no significant effect on the prognosis of acute non-ST segment elevation myocardial infarction.3.Subgroup analysis showed that:(1)different D-dimer levels had no effect on the survival time of patients with acute non-ST segment elevation myocardial infarction with MACE events.(2)for people with MACE events over 75 years of age,With the increase of D-dimer level,the incidence of MACE events also increased significantly.(3)for the drug conservative group,with the increase of D-dimer level,the incidence of MACE events also increased.(3)for the drug conservative group,the incidence of MACE events increased with the increase of D-dimer level.