Associations between postprocedural D-dimer, hs-CRP, LDL-C levels and prognosis of acute myocardial infarction patients treated by percutaneous coronary intervention.
10.3760/cma.j.cn112148-20190829-00527
- VernacularTitle:急性心肌梗死经皮冠状动脉介入治疗术后D-二聚体、高敏C反应蛋白及LDL-C水平与预后的关系
- Author:
Run Zhen CHEN
1
;
Chen LIU
1
;
Peng ZHOU
1
;
Yu TAN
1
;
Zhao Xue SHENG
1
;
Jian Nan LI
1
;
Jin Ying ZHOU
1
;
Yuan WU
1
;
Yan Min YANG
1
;
Li SONG
1
;
Han Jun ZHAO
1
;
Hong Bing YAN
2
,
3
Author Information
1. Coronary Heart Disease Center, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China.
2. Coronary Heart Disease Center, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
3. Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, Shenzhen 518000, China.
- Publication Type:Journal Article
- Keywords:
D-dimer;
High-sensitivity C-reactive protein;
Low-density lipoprotein cholesterol;
Myocardial infarction;
Percutaneous coronary intervention;
Prognosis
- MeSH:
Aged;
Biomarkers;
C-Reactive Protein;
Cholesterol, LDL;
Female;
Fibrin Fibrinogen Degradation Products;
Humans;
Male;
Middle Aged;
Myocardial Infarction/surgery*;
Percutaneous Coronary Intervention;
Prognosis
- From:
Chinese Journal of Cardiology
2020;48(5):359-366
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To investigate the association between postprocedural D-dimer, high sensitivity C-reactive protein(hs-CRP) and low-density lipoprotein-cholesterol(LDL-C) and outcomes of acute myocardial infarction (AMI) patients treated by percutaneous coronary intervention(PCI), in order to clarify the impacts of thrombotic, inflammatory and cholesterol risks on long-term prognosis. Methods: Patients with AMI who underwent emergency PCI from January 2010 to June 2017 in Fuwai Hospital with complete baseline data were enrolled. Patients were stratified into four groups according to quartiles of D-dimer, hs-CRP and LCL-C. Cox regression was used to analyze the relationship between these biomarkers and prognosis. Restricted cubic spline (RCS) was used to characterize the continuous association between risk of all-cause death and biomarkers. The primary outcome was all-cause death. Results: A total of 3 614 patients were included in the analysis. The age was (59.2±12.0) years old, and 2 845 (78.7%) were male and 3 161 (87.5%) patients were diagnosed as ST-segment elevation myocardial infarction. The follow-up time was 652 (414, 1 880) days. Survival analysis showed that postprocedural D-dimer and hs-CRP were significantly associated with all-cause mortality (all P<0.05). Cox regression with multiple adjustments showed that patients with D-dimer≥580 μg/L presented higher risk of all-cause death (HR=2.03, 95%CI 1.22-3.38, P=0.006), compared to patients with D-dimer<220 μg/L. RCS analysis showed that risk of all-cause death was stably high when D-dimer reached 500 μg/L. Multivariable Cox regression also showed that patients with hs-CRP<2.74 mg/L (HR=1.86, 95%CI 1.10-3.15, P=0.020)or hs-CRP≥11.99 mg/L (HR=2.14, 95%CI 1.35-3.40, P=0.001) presented higher mortality compared to patients whose hs-CRP was 2.74-7.18 mg/L. RCS analysis indicated a J-shaped relation between hs-CRP and mortality, as greater risk of death was observed when hs-CRP was lower than 2 mg/L or higher than 10 mg/L. LDL-C was not associated with outcomes (all P>0.05). Conclusions: Postprocedural D-dimer is significantly associated with long-term prognosis of AMI patients treated by PCI. Patients with extremely high or low levels of hs-CRP presents worse outcomes. Intensive and tailored antithrombotic or anti-inflammatory therapies should be considered for patients with increased thrombotic risk and those with extremely high or low inflammatory risk.
