The Value Of The Ratio Of D-dimer To EGFR In Predicting The Long-term Mortality Of Coronary Heart Disease After PCI

BackgroundCoronary heart disease(CHD)is a heart attack in which atherosclerotic lesions in the coronary arteries narrow or block the lumen,resulting in myocardial ischemia,hypoxia,or necrosis.According to the statistics of "China cardiovascular disease report 2018",the death of cardiovascular disease accounts for the first cause of death among urban and rural residents.With the development of medical level,more and more patients with coronary heart disease choose percutaneous coronary intervention.Therefore,it has become a hot topic to explore effective and efficient indicators to evaluate the prognosis of coronary heart disease patients with PCI.Previous literature has shown that d-dimer is the product of the descending solution of cross-linked fibrin in fibrinolytic enzyme,the coagulation system and fibrinolytic system are in a dynamic balance in vivo,and the fibrinolytic system is activated at the same time during thrombus formation in vivo,so the increase of d-dimer can reflect the hyperactivity of thrombus formation and fibrinolytic system in vivo.Studies have shown that d-dimer can predict the prognosis of patients with ST elevation myocardial infarction after interventional therapy.The estimated glomerular rate filtration can reflect renal function and predict the prognosis of stable coronary heart disease.Previous study showed that D-dimer,a marker of coagulation Status,is divided into 3 groups,and eGFR of the reflection renal function is divided into 2 groups,Then the combination of d-dimer and the estimated glomerular rate filtration can effectively predict the prognosis of stable coronary heart disease and is better than a single indicator.So the aim of this study is to investigate whether the ratio of d-dimer to estimated glomerular rate filtration could effectively predict the prognosis of patients with coronary heart disease after PCI.Objective:The prognostic value of the ratio of D-Dimer and estimation of glomerul arfiltration rate(eGFR)(DeGFR)for long-term death has not been fully evaluated in coronary heart diseases(CHD)patients with Percutaneous coronary interention(PCI).Methods:.A retrospective cohort study was conducted to include 3561 patients diagnosed with coronary heart disease and undergoing percutaneous coronary intervention(PCI)in the First Affiliated Hospital of Zhengzhou University from January 2013 to December 2017.The patients with infection,tumor and without baseline data were excluded,and finally 1505 patients were enrolled in the study.General data in including blood routine,coagulation function,renal function and other indicators of the patients were collected.According to DeGFR,the patients were divided into low value group(DeGFR<0.67)497 cases,median value group(0.67?DeGFR<1.5)504 cases,and high value group(DeGFR?1.5)504 cases,to evaluate the correlation between DeGFR and long-term prognosis of coronary heart disease after PCI.The subjects were followed up.After PCI,the patients were followed up by telephone or letter,with an average follow-up time of 37.59 ±22.24 months.The prognosis of the patients was recorded,including death,cardiogenic death,MACE,and MACCE events.SPSS 22.0 software was used for statistical analysis.Normally distributed variables are expressed as mean values±standard deviations,intergroup differences were evaluated using analysis of variance or the Test for continuous variables and the chi-square test for categorical variables.Multivariate Cox regression analysis was used to evaluate the predictive value of d-dimer to eGFR ratio on long-term mortality risk after PCI in patients with coronary heart disease.Kaplan-Meier survival curve was used to compare the cumulative risk of adverse events among the three groups,and the differences among the three groups were compared by Log rank test.The test level was set as a=0.05,and P<0.05 was considered statistically significant in comparison between groups.Results:1.The difference in age,family history,age,gender,LVEF,urea,creatinine,D-dimer and the ratio of eGFR,the GGTP(gamma glutamyl transpeptidase)was statistically significant among three groups of patients(P<0.05),in the heart rate,blood sugar,uric acid,cereal third transaminase,aspertate aminotransferase,total protein,triglyceride,total cholesterol,LDLC,differences in HDLC history,history of diabetes,high blood pressure was no statistical significance(P<0.05).2.Single-factor analysis showed that the differences in All-cause death(1.2%vs 2.2%vs 4.4%,P=0.006)and Cardiovascular death(0.6%vs 1.8%vs 3.4%,P=0.006)between the high-value group and the low-value group were statistically significant(P<0.05).3.Cox regression analysis showed that compared with the low-value group,the high-value group of DeGFR was an independent risk factor for predicting the risk of All-cause death(HR=3.945,95%ci:1.539-10.111,P=0.004)and Cardiovascular death(HR=6.226,95%ci:1.726-22.454,P=0.005)of acute coronary syndrome after PCI.Conclusions:DeGFR is an independent risk factor for long-term outcomes in patients with coronary heart disease after PCI.