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D-Dimer Levels Predict Myocardial Injury in ST-Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study

OBJECTIVES: Elevated D-dimer levels on admission predict prognosis in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), but the association of D-dimer levels with structural markers of myocardial injury in these patients is u...

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Autores principales: Choi, Soonuk, Jang, Woo Jin, Song, Young Bin, Lima, Joao A. C., Guallar, Eliseo, Choe, Yeon Hyeon, Hwang, Jin Kyung, Kim, Eun Kyoung, Yang, Jeong Hoon, Hahn, Joo-Yong, Choi, Seung-Hyuk, Lee, Sang-Chol, Lee, Sang Hoon, Gwon, Hyeon-Cheol
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981325/
https://www.ncbi.nlm.nih.gov/pubmed/27513758
http://dx.doi.org/10.1371/journal.pone.0160955
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author Choi, Soonuk
Jang, Woo Jin
Song, Young Bin
Lima, Joao A. C.
Guallar, Eliseo
Choe, Yeon Hyeon
Hwang, Jin Kyung
Kim, Eun Kyoung
Yang, Jeong Hoon
Hahn, Joo-Yong
Choi, Seung-Hyuk
Lee, Sang-Chol
Lee, Sang Hoon
Gwon, Hyeon-Cheol
author_facet Choi, Soonuk
Jang, Woo Jin
Song, Young Bin
Lima, Joao A. C.
Guallar, Eliseo
Choe, Yeon Hyeon
Hwang, Jin Kyung
Kim, Eun Kyoung
Yang, Jeong Hoon
Hahn, Joo-Yong
Choi, Seung-Hyuk
Lee, Sang-Chol
Lee, Sang Hoon
Gwon, Hyeon-Cheol
author_sort Choi, Soonuk
collection PubMed
description OBJECTIVES: Elevated D-dimer levels on admission predict prognosis in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), but the association of D-dimer levels with structural markers of myocardial injury in these patients is unknown. METHODS: We performed cardiac magnetic resonance (CMR) imaging in 208 patients treated with primary PCI for STEMI. CMR was performed a median of 3 days after the index procedure. Of the 208 patients studied, 75 patients had D-dimer levels above the normal range on admission (>0.5 μg/mL; high D-dimer group) while 133 had normal levels (≤0.5 μg/mL; low D-dimer group). The primary outcome was myocardial infarct size assessed by CMR. Secondary outcomes included area at risk (AAR), microvascular obstruction (MVO) area, and myocardial salvage index (MSI). RESULTS: In CMR analysis, myocardial infarct size was larger in the high D-dimer group than in the low D-dimer group (22.3% [16.2–30.5] versus 18.8% [10.7–26.7]; p = 0.02). Compared to the low D-dimer group, the high D-dimer group also had a larger AAR (38.1% [31.7–46.9] versus 35.8% [24.2–45.3]; p = 0.04) and a smaller MSI (37.7 [28.2–46.9] versus 47.1 [33.2–57.0]; p = 0.01). In multivariate analysis, high D-dimer levels were significantly associated with larger myocardial infarct (OR 2.59; 95% CI 1.37–4.87; p<0.01) and lower MSI (OR 2.62; 95% CI 1.44–4.78; p<0.01). CONCLUSIONS: In STEMI patients undergoing primary PCI, high D-dimer levels on admission were associated with a larger myocardial infarct size, a greater extent of AAR, and lower MSI, as assessed by CMR data. Elevated initial D-dimer level may be a marker of advanced myocardial injury in patients treated with primary PCI for STEMI.
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spelling pubmed-49813252016-08-29 D-Dimer Levels Predict Myocardial Injury in ST-Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study Choi, Soonuk Jang, Woo Jin Song, Young Bin Lima, Joao A. C. Guallar, Eliseo Choe, Yeon Hyeon Hwang, Jin Kyung Kim, Eun Kyoung Yang, Jeong Hoon Hahn, Joo-Yong Choi, Seung-Hyuk Lee, Sang-Chol Lee, Sang Hoon Gwon, Hyeon-Cheol PLoS One Research Article OBJECTIVES: Elevated D-dimer levels on admission predict prognosis in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), but the association of D-dimer levels with structural markers of myocardial injury in these patients is unknown. METHODS: We performed cardiac magnetic resonance (CMR) imaging in 208 patients treated with primary PCI for STEMI. CMR was performed a median of 3 days after the index procedure. Of the 208 patients studied, 75 patients had D-dimer levels above the normal range on admission (>0.5 μg/mL; high D-dimer group) while 133 had normal levels (≤0.5 μg/mL; low D-dimer group). The primary outcome was myocardial infarct size assessed by CMR. Secondary outcomes included area at risk (AAR), microvascular obstruction (MVO) area, and myocardial salvage index (MSI). RESULTS: In CMR analysis, myocardial infarct size was larger in the high D-dimer group than in the low D-dimer group (22.3% [16.2–30.5] versus 18.8% [10.7–26.7]; p = 0.02). Compared to the low D-dimer group, the high D-dimer group also had a larger AAR (38.1% [31.7–46.9] versus 35.8% [24.2–45.3]; p = 0.04) and a smaller MSI (37.7 [28.2–46.9] versus 47.1 [33.2–57.0]; p = 0.01). In multivariate analysis, high D-dimer levels were significantly associated with larger myocardial infarct (OR 2.59; 95% CI 1.37–4.87; p<0.01) and lower MSI (OR 2.62; 95% CI 1.44–4.78; p<0.01). CONCLUSIONS: In STEMI patients undergoing primary PCI, high D-dimer levels on admission were associated with a larger myocardial infarct size, a greater extent of AAR, and lower MSI, as assessed by CMR data. Elevated initial D-dimer level may be a marker of advanced myocardial injury in patients treated with primary PCI for STEMI. Public Library of Science 2016-08-11 /pmc/articles/PMC4981325/ /pubmed/27513758 http://dx.doi.org/10.1371/journal.pone.0160955 Text en © 2016 Choi et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Choi, Soonuk
Jang, Woo Jin
Song, Young Bin
Lima, Joao A. C.
Guallar, Eliseo
Choe, Yeon Hyeon
Hwang, Jin Kyung
Kim, Eun Kyoung
Yang, Jeong Hoon
Hahn, Joo-Yong
Choi, Seung-Hyuk
Lee, Sang-Chol
Lee, Sang Hoon
Gwon, Hyeon-Cheol
D-Dimer Levels Predict Myocardial Injury in ST-Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study
title D-Dimer Levels Predict Myocardial Injury in ST-Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study
title_full D-Dimer Levels Predict Myocardial Injury in ST-Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study
title_fullStr D-Dimer Levels Predict Myocardial Injury in ST-Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study
title_full_unstemmed D-Dimer Levels Predict Myocardial Injury in ST-Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study
title_short D-Dimer Levels Predict Myocardial Injury in ST-Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study
title_sort d-dimer levels predict myocardial injury in st-segment elevation myocardial infarction: a cardiac magnetic resonance imaging study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981325/
https://www.ncbi.nlm.nih.gov/pubmed/27513758
http://dx.doi.org/10.1371/journal.pone.0160955
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