The correlation of D-dimer levels with patient outcomes in acute ischemic cerebrovascular disease complicating coronary heart disease.
OBJECTIVE
To investigate the correlation between nerve function defect, their degree of recovery, and D-dimer levels in patients with acute ischemic cerebrovascular disease (AICVD) complicating coronary heart disease (CHD) in winter.


METHODS
From 1 October, 2014 to 31 December, 2014, we enrolled patients in a consecutive manner with AICVD who were hospitalized in the Department of Neurology, Beijing Luhe hospital, Capital Medical University. The patients were selected that had an occurrence of AICVD within the last 14 days. A total of 151 cases were divided into CHD group (n = 77) or non-CHD group (n = 74) based on a diagnosis of CHD. The risk factors, hematological indices associated with the diseases, and the nerve function defect and recovery degrees were compared between the two groups. Moreover, according to the result of the preliminary analysis of the CHD and non-CHD groups, patients were further divided into two subgroups based on whether their D-dimer levels were higher than 0.5 mg/l or not. Finally, the nerve function defect and recovery degrees in each subgroups were compared in pairs.


RESULTS
Among the patients consecutively enrolled, the percentage of the patients with CHD was 50.99% (77/151) and non-CHD patients was 49.01%. On admission, there was no significant difference in NIHSS scores between the CHD and non-CHD groups. However, there was a significant difference between the CHD and non-CHD groups when comparing the NIHSS scores on 14th day and the mRs scores on 90 (±7)th day after the initial onset (p = 0.006, 0.005). The D-dimer levels of AICVD complicating CHD patients were higher than those not complicating CHD patients (p = 0.006). Those AICVD patients that complicating CHD with also elevated D-dimer levels had most severe neurologic function deficits on 14th day and worst neural function recoveries on 90 (±7)th day after onset (p = 0.001, <0.001).


CONCLUSIONS
AICVD patients complicating CHD is very common in clinical practice. The AICVD patients that complicating CHD showed worse outcomes within 90 days after initial onset of stroke. The D-dimer levels of patients with AICVD complicating CHD were higher. Patients in the CHD group, whose D-dimer levels were higher than the normal standard, had worst outcomes. Paying close attention to the stage of the coronary artery disease and indicators of the coagulation-fibrinolysis is beneficial in the optimization of the clinical treatment for AICVD patients. Maybe the results of this study could provide some reference for specific groups of stroke patients to accept anticoagulant therapy.
a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China.|c Department of Neurology , Xuanwu Hospital, Capital Medical University , Beijing , China.
Yanling
Y
Wang
b Department of Neurological Surgery , Wayne State University School of Medicine , Detroit , MI , USA.
Adam
A
Hafeez
a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China.
Fanhua
F
Meng
a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China.
Ruihua
R
Zhang
a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China.
Xuemei
X
Wang
a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China.
Xiaomeng
X
Chen
c Department of Neurology , Xuanwu Hospital, Capital Medical University , Beijing , China.
Qi
Q
Kong
a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China.
Huishan
H
Du
c Department of Neurology , Xuanwu Hospital, Capital Medical University , Beijing , China.
Xin
X
Ma
D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D002561:Cerebrovascular Disorders / Q000097:blood* / Q000209:etiology*; D003327:Coronary Disease / Q000150:complications*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013223:Statistics as Topic
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D002097:C-Reactive Protein
Acute ischemic stroke; Coronary heart disease; D-dimer