Predictive value of elevated D-dimer in patients undergoing primary angioplasty for ST elevation myocardial infarction

The aim of this study was to evaluate the prognostic value of D-dimer in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). The prognostic value of D-dimer has been documented in patients with acute coronary syndrome without ST-segment elevation. However, its value in acute ST-segment elevation myocardial infarction (STEMI) remains unclear. We prospectively enrolled 453 consecutive STEMI patients (mean age 55.6 +/- 12.4 years, 364 male, 89 female) undergoing primary PCI. The study population was divided into tertiles based on admission D-dimer values. The high D-dimer group (n=151) was defined as a value in the third tertile [>0.72ug/ml fibrinogen equivalent units (FEU)], and the low D-dimer group (n=302) included those patients with a value in the lower two tertiles (0.72ug/ml FEU). Clinical characteristics, in-hospital and 6-month outcomes of primary PCI were analyzed. The patients of the high D-dimer group were older (mean age 60.1 +/- 13.5 versus 52.4 +/- 10.6, P<0.001). Higher in-hospital cardiovascular mortality and 6-month all-cause mortality rates were observed in the high D-dimer group (7.2 versus 0.6%, P<0.001 and 13.9 versus 2%, P<0.001, respectively). In Cox multivariate analysis; a high admission D-dimer value (>0.72ug/ml FEU) was found to be a powerful independent predictor of 6-month all-cause mortality (odds ratio: 10.1, 95% confidence interval: 1.24-42.73, P=0.03). These results suggest that a high admission D-dimer, level was associated with increased in-hospital cardiovascular mortality and 6-month all-cause mortality in patients with STEMI undergoing primary PCI. (C) 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.