Prognostic Value of Age-Adjusted D-Dimer Cutoff Thresholds in Patients with Acute Coronary Syndrome Treated by Percutaneous Coronary Intervention

Runzhen Chen; Chen Liu; Peng Zhou; Jiannan Li; Jinying Zhou; Ruoqi Song; Weida Liu; Yi Chen; Li Song; Hanjun Zhao; Hongbing Yan

doi:10.2147/CIA.S347168

Prognostic Value of Age-Adjusted D-Dimer Cutoff Thresholds in Patients with Acute Coronary Syndrome Treated by Percutaneous Coronary Intervention

Clin Interv Aging. 2022 Feb 9:17:117-128. doi: 10.2147/CIA.S347168. eCollection 2022.

Authors

Runzhen Chen^{1

2}, Chen Liu^{1

2

3}, Peng Zhou^{1

3}, Jiannan Li¹, Jinying Zhou¹, Ruoqi Song⁴, Weida Liu⁴, Yi Chen¹, Li Song^{1

3}, Hanjun Zhao^{1

3}, Hongbing Yan^{2

3}

Affiliations

¹ Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
² Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China.
³ Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
⁴ State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.

Abstract

Background: Associations between D-dimer and outcomes of patients with acute coronary syndrome (ACS) remain controversial. Using age-adjusted D-dimer cutoff thresholds improve the diagnostic accuracy for thrombotic diseases. This study aimed to investigate the prognostic value of age-adjusted D-dimer in ACS patients treated by percutaneous coronary intervention (PCI).

Methods: A total of 3972 consecutive patients with ACS treated by PCI were retrospectively recruited. The basal age-adjusted D-dimer threshold was 500 ng/mL and was calculated as age × 10 in patients older than 50 years. Cox regression was used for outcome analysis. C-index, net reclassification index (NRI), and integrated discrimination improvement (IDI) were calculated to assess the additional prognostic value of age-adjusted D-dimer when combined with established clinical risk factors. The primary outcome was all-cause death.

Results: During a median follow-up of 720 days, a total of 225 deaths occurred. High D-dimer level, as defined by age-adjusted thresholds, was an independent predictor for all-cause death (hazard ratio [HR]: 1.75, 95% confidence interval [CI]: 1.32-2.31, P < 0.001), cardiac death (HR: 1.84, 95% CI: 1.30-2.60, P = 0.001), and MACE (HR: 1.48, 95% CI: 1.19-1.83, P < 0.001). Sensitivity and subgroup analysis showed that high D-dimer levels were constantly associated with worse outcomes across common risk factors and comorbidities. Besides, age-adjusted elevation of D-dimer significantly improved the risk predictions for all-cause death when added to the model of established risk factors (C-index: 0.846 vs 0.838, Δ C-index: 0.008, 95% CI: 0.001-0.015, P_difference = 0.027; NRI: 0.645, 95% CI: 0.464-0.826, P < 0.001; IDI: 0.008, 95% CI: 0.001-0.017, P = 0.048).

Conclusion: In ACS patients treated by PCI, age-adjusted elevation of D-dimer was an independent predictor for adverse outcomes and improved the risk predictions for long-term mortality.

Keywords: ACS; D-dimer; PCI; acute coronary syndrome; aging; percutaneous coronary intervention.

MeSH terms

Acute Coronary Syndrome*
Biomarkers
Fibrin Fibrinogen Degradation Products
Humans
Percutaneous Coronary Intervention* / adverse effects
Prognosis
Retrospective Studies
Risk Assessment
Risk Factors
Treatment Outcome

Substances

Biomarkers
Fibrin Fibrinogen Degradation Products
fibrin fragment D

Grants and funding

This study was supported by the National Natural Science Foundation of China (81970308), the Fund of “Sanming” Project of Medicine in Shenzhen (SZSM201911017), Shenzhen Key Medical Discipline Construction Fund (SZXK001), and the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2016-I2M-1-009).