title: The value of plasma D-dimer level on admission in predicting no-reflow after primary percutaneous coronary intervention and long-term prognosis in patients with acute ST segment elevation myocardial infarction.
abstract: D-dimer is a final product of fibrin degradation and gives an indirect estimation of the thrombotic burden. We aimed to investigate the value of plasma D-dimer levels on admission in predicting no-reflow after primary percutaneous coronary intervention (p-PCI) and long-term prognosis in patients with ST segment elevation myocardial infarction (STEMI). We retrospectively involved 569 patients treated with p-PCI for acute STEMIs. We prospectively followed up the patients for a median duration of 38 months. Angiographic no-reflow was defined as postprocedural thrombolysis in myocardial infarction (TIMI) flow grade <3 or TIMI 3 with a myocardial blush grade <2. Electrocardiographic no-reflow was defined as ST-segment resolution <70%. The primary clinical end points were mortality and major adverse cardiovascular events (MACE). The incidences of angiographic and electrocardiographic no-reflow were 31 and 39% respectively. At multivariable analysis, D-dimer was found to be an independent predictor of both angiographic (p < 0.001), and electrocardiographic (p < 0.001) no-reflow. Both mortality (from Q1 to Q4, 5.7, 6.4, 11.3 and 34.1%, respectively, p < 0.001) and MACE (from Q1 to Q4, 17.9, 29.3, 36.9 and 52.2%, respectively, p < 0.001) rates at long-term follow-up were highest in patients with admission D-dimer levels in the highest quartile (Q4), compared to the rates in other quartiles. However, Cox proportional hazard model revealed that high D-dimer on admission (Q4) was not an independent predictor of mortality or MACE. In contrast, electrocardiographic no-reflow was independently predictive of both mortality [Hazard ratio (HR) 2.88, 95% confidence interval (CI) 1.04-8.58, p = 0.041] and MACE [HR 1.90, 95% CI 1.32-4.71, p = 0.042]. In conclusion, plasma D-dimer level on admission independently predicts no-reflow after p-PCI. However, D-dimer has no independent prognostic value in patients with STEMI.
authors.affiliation: Department of Cardiology, Kocaeli Derince Education and Research Hospital, İbni Sina Bulvarı, Derince, Kocaeli, Turkey, ayhanerkol@yahoo.com.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Erkol
authors.forename: Vecih
authors.initials: V
authors.lastname: Oduncu
authors.forename: Burak
authors.initials: B
authors.lastname: Turan
authors.forename: Alev
authors.initials: A
authors.lastname: Kılıçgedik
authors.forename: Dicle
authors.initials: D
authors.lastname: Sırma
authors.forename: Gökhan
authors.initials: G
authors.lastname: Gözübüyük
authors.forename: Can Yücel
authors.initials: CY
authors.lastname: Karabay
authors.forename: Ahmet
authors.initials: A
authors.lastname: Guler
authors.forename: Cihan
authors.initials: C
authors.lastname: Dündar
authors.forename: Kürşat
authors.initials: K
authors.lastname: Tigen
authors.forename: Selçuk
authors.initials: S
authors.lastname: Pala
authors.forename: Cevat
authors.initials: C
authors.lastname: Kırma
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D010343:Patient Admission; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D