Predictive Values Of D-dimer For The Prognosis Of Acute ST-segment Elevation Infarction

Background: D-dimer is a primary degradation product of cross-linked fibrin,and can be an effective diagnostic factor of venous thromboembolism(VTE).However,its prognostic role in patients with acute ST-segment elevation myocardial infarction(STEMI)remains controversial.This study aimed to investigate whether D-dimer has a predictive value for short-term and long-term adverse cardiac events in STEMI patients after acute percutaneous coronary intervention(PCI).Methods: We retrospectively enrolled 872 STEMI patients treated with primary percutaneous coronary intervention(p-PCI).Patients were divided into quartiles according to their admission D-dimer increased multiple(the levels of D-dimer divided by the upper limit of the normal range of D-dimer),with the highest quartile(G4)(n=219)defined as increased multiple ? 1.33,and the lowest quartile(G1)(n=215)as increased multiple ?0.33.Results: Compared with G1,higher in-hospital heart failure(40.2%versus 10.2%,p <0.001),malignant arrhythmia(14.2% versus 2.3%,p<0.001)and all-cause mortality(5.9% versus 0%,p <0.001)rates were observed in G4.After a follow-up period of 29-months,84 patients had died.In the Cox multivariate analysis,age,Kiilp class ? 2 and a high admission D-dimer increased multiple(? 1.33)were found to be independent predictors of all-cause mortality.Conclusion: This study showed that there was an association between a high D-dimer level and the increasing in major adverse cardiac events during hospitalization,such as heart failure,malignant arrhythmias,rehospitalization,revascularisation,death.High D-dimer level was also an independent predictor of long-term all-cause mortality.All the above results suggest that the level of D-dimer has a predictive value for the prognosis of STEMI patients.Previous studies have found that the potential mechanism of the relationship between D-dimer and prognosis in STEMI patients may be related to no reflow.No reflow is caused by microcirculation embolism,ischemia-reperfusion injury,endothelial dysfunction and other complex factors.It refers to non-effective perfusion in myocardium when the flow regains after flow blockage resulting from coronary artery occlusion.It will increase the risk of cardiac arrhythmia,congestive heart failure,myocardial infarction and death in the prognosis.D-dimer as an indicator of thrombotic burden,a high D-dimer level not only can indicate the severity of coronary microvascular embolism,but also is one of the important predictors of no reflow in STEMI patients.This suggests that doctors should pay moreattention to the prevention of no-reflow during PCI for STEMI patients with high D-dimer levels,and more active follow-up and treatment measures should be taken after PCI.