Predictive value of D-dimer for in-hospital mortality and heart failure with reduced ejection fraction in patients with acute myocardial infarction
10.12025/j.issn.1008-6358.2026.20260408
- VernacularTitle:D-二聚体对急性心肌梗死患者院内死亡及射血分数降低型心力衰竭的预测价值
- Author:
Jianquan LIAO
1
;
Yinman WANG
1
;
Haibin CHEN
2
;
Yong FU
2
;
Huaxing GAO
2
;
Runda WU
1
;
Zhixiang WANG
1
;
Kang YAO
1
;
Junbo GE
1
Author Information
1. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, China.
2. Department of Cardiology, People’s Hospital of Jinping Miao, Yao and Dai Autonomous County, Jinping 661500, Yunnan, China.
- Publication Type:Originalarticle
- Keywords:
acute myocardial infarction;
D-dimer;
in-hospital mortality;
heart failure with reduced ejection fraction;
risk stratification
- From:
Chinese Journal of Clinical Medicine
2026;33(5):790-796
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the predictive value of D-dimer for in-hospital mortality and heart failure with reduced ejection fraction (HFrEF) in patients with acute myocardial infarction (AMI). Methods A total of 688 patients with AMI who were hospitalized at Zhongshan Hospital, Fudan University, from January 2020 to December 2023 were retrospectively enrolled. Demographic and clinical characteristics, laboratory findings, echocardiographic parameters, and in-hospital outcomes were collected. Patients were divided into four groups according to D-dimer quartiles, and trend tests were used to compare changes in each indicator with increasing D-dimer levels. The primary endpoints were in-hospital mortality and HFrEF. Multivariable logistic regression analysis was performed to assess the independent associations of D-dimer with in-hospital mortality and HFrEF. Receiver operating characteristic (ROC) curve analysis was used to evaluate its predictive performance. Results Differences and trend tests among four groups for age, creatinine, peak cardiac troponin T, N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction, HFrEF incidence, and in-hospital mortality were statistically significant (P＜0.05). Multivariable logistic regression analysis showed that elevated D-dimer was associated with an increased risk of in-hospital mortality in patients with AMI (OR＝1.251, 95%CI 1.093–1.432, P＝0.001), and HFrEF (OR＝1.075, 95%CI 1.028–1.124, P＝0.002). ROC curve analysis showed that the area under the curve (AUC) of D-dimer for predicting in-hospital mortality and HFrEF were 0.871 and 0.716, respectively. At a cutoff value of 0.47 mg/L, the sensitivity and specificity of D-dimer in predicting HFrEF were 81.9% and 52.1%, respectively; at a cutoff value of 2.18 mg/L, the sensitivity and specificity of D-dimer in predicting in-hospital mortality were 63.6% and 93.8%, respectively. Restricted cubic spline analysis demonstrated significant non-linear associations between D-dimer and the risks of in-hospital mortality and HFrEF (P＜0.001). Conclusions Elevated D-dimer level is significantly associated with increased risks of in-hospital mortality and HFrEF in patients with AMI and shows acceptable predictive performance. As a simple and readily available laboratory biomarker, D-dimer may provide useful information for early risk stratification and clinical management in patients with AMI.
