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D-Dimer Level Predicts Angiographic No-Reflow Phenomenon After Percutaneous Coronary Intervention Within 2–7 Days of Symptom Onset in Patients with ST-Segment Elevation Myocardial Infarction

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Abstract

It remains uncertain whether plasma D-dimer level can predict no-reflow in patients with STEMI who had pPCI after 48 h of symptom onset. This study retrospectively enrolled 229 consecutive patients who had pPCI for acute STEMI within 2–7 days of symptom onset between January 2008 and December 2018. Patients were divided into no-reflow group (TIMI flow grade 0–2) and reflow group (TIMI flow grade 3). Predictors of no-reflow were assessed by univariate and multivariate binary logistic regression analyses. Plasma D-dimer level can independently predict no-reflow in patients with STEMI who had pPCI within 2–7 days of symptom onset (OR 2.52 per 1 mg/L increase, 95% CI 1.16–5.47, p = 0.019). This finding indicated that pPCI may be safe and feasible for STEMI patients within 2–7 days of symptom onset with low D-dimer level.

Plasma D-dimer level can independently predict no-reflow in patients with STEMI who had pPCI within 2–7 days of symptom onset. pPCI may be safe and feasible for STEMI patients within 2–7 days of symptom onset with low D-dimer level.

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Abbreviations

cTnT:

Cardiac troponin T

ECG:

Electrocardiogram

eGFR:

Estimated glomerular filtration rate

hs-CRP:

High-sensitivity C-reactive protein

IRA:

Infarct-related artery

MACE:

Major cardiovascular adverse events

MI:

Myocardial infarction

NT-pro BNP:

N-terminal pro-B-type natriuretic peptide

pPCI:

Primary percutaneous coronary intervention

PTCA:

Percutaneous transluminal coronary angioplasty

STEMI:

ST-segment elevation myocardial infarction

TIMI:

Thrombolysis in myocardial infarction

References

  1. Ibanez, B., James, S., Agewall, S., et al. (2018). 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (esc). European Heart Journal, 39, 119–177.

    Article  Google Scholar 

  2. Authors/Task Force m, Windecker, S., Kolh, P., et al. (2014). 2014 ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). European Heart Journal, 35, 2541–2619.

    Article  Google Scholar 

  3. Eagle, K. A., Goodman, S. G., Avezum, A., et al. (2002). Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE). Lancet, 359, 373–377.

    Article  Google Scholar 

  4. Hochman, J. S., Lamas, G. A., Buller, C. E., et al. (2006). Coronary intervention for persistent occlusion after myocardial infarction. The New England Journal of Medicine, 355, 2395–2407.

    Article  CAS  Google Scholar 

  5. Celik, T., Balta, S., Demir, M., et al. (2016). Predictive value of admission red cell distribution width-platelet ratio for no-reflow phenomenon in acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiology Journal, 23, 84–92.

    Article  Google Scholar 

  6. Ndrepepa, G., Tiroch, K., Fusaro, M., et al. (2010). 5-year prognostic value of no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction. Journal of the American College of Cardiology, 55, 2383–2389.

    Article  Google Scholar 

  7. Rezkalla, S. H., & Kloner, R. A. (2008). Coronary no-reflow phenomenon: from the experimental laboratory to the cardiac catheterization laboratory. Catheterization and Cardiovascular Interventions, 72, 950–957.

    Article  Google Scholar 

  8. Napodano, M., Ramondo, A., Tarantini, G., et al. (2009). Predictors and time-related impact of distal embolization during primary angioplasty. European Heart Journal, 30, 305–313.

    Article  Google Scholar 

  9. Izgi, A., Kirma, C., Tanalp, A. C., et al. (2007). Predictors and clinical significance of angiographically detected distal embolization after primary percutaneous coronary interventions. Coronary Artery Disease, 18, 443–449.

    Article  Google Scholar 

  10. Mathew, V., & Gersh, B. J. (2004). To open or not to open: that remains the question. European Heart Journal, 25, 2177–2179.

    Article  Google Scholar 

  11. Hou, H., Ge, Z., Ying, P., et al. (2012). Biomarkers of deep venous thrombosis. Journal of Thrombosis and Thrombolysis, 34, 335–346.

    Article  CAS  Google Scholar 

  12. Erkol, A., Oduncu, V., Turan, B., et al. (2014). The value of plasma D-dimer level on admission in predicting no-reflow after primary percutaneous coronary intervention and long-term prognosis in patients with acute ST segment elevation myocardial infarction. Journal of Thrombosis and Thrombolysis, 38, 339–347.

    Article  CAS  Google Scholar 

  13. Zhang, H., Qiu, B., Zhang, Y., et al. (2018). The value of pre-infarction angina and plasma D-dimer in predicting no-reflow after primary percutaneous coronary intervention in ST-segment elevation acute myocardial infarction patients. Medical Science Monitor, 24, 4528–4535.

    Article  CAS  Google Scholar 

  14. Sarli, B., Akpek, M., Baktir, A. O., et al. (2015). Impact of D-dimer level on postinterventional coronary flow and in-hospital mace in ST-segment elevation myocardial infarction. Herz, 40, 507–513.

    Article  CAS  Google Scholar 

  15. Alpert, J. S. (2018). The fourth edition of the universal definition of myocardial infarction. The American Journal of Medicine, 131, 1265–1266.

    Article  Google Scholar 

  16. Gibson, C. M., Murphy, S. A., Rizzo, M. J., et al. (1999). Relationship between TIMI frame count and clinical outcomes after thrombolytic administration. Thrombolysis in myocardial infarction (TIMI) study group. Circulation, 99, 1945–1950.

    Article  CAS  Google Scholar 

  17. Rezkalla, S. H., & Kloner, R. A. (2002). No-reflow phenomenon. Circulation, 105, 656–662.

    Article  Google Scholar 

  18. Gibson, C. M., de Lemos, J. A., Murphy, S. A., et al. (2001). Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a timi 14 substudy. Circulation, 103, 2550–2554.

    Article  CAS  Google Scholar 

  19. Gottdiener, J. S., Bednarz, J., Devereux, R., et al. (2004). American society of echocardiography recommendations for use of echocardiography in clinical trials. Journal of the American Society of Echocardiography, 17, 1086–1119.

    PubMed  Google Scholar 

  20. Horie, H., Takahashi, M., Minai, K., et al. (1998). Long-term beneficial effect of late reperfusion for acute anterior myocardial infarction with percutaneous transluminal coronary angioplasty. Circulation, 98, 2377–2382.

    Article  CAS  Google Scholar 

  21. Steg, P. G., Thuaire, C., Himbert, D., et al. (2004). Decopi (desobstruction coronaire en post-infarctus): a randomized multi-centre trial of occluded artery angioplasty after acute myocardial infarction. European Heart Journal, 25, 2187–2194.

    Article  Google Scholar 

  22. Hochman, J. S., Lamas, G. A., Knatterud, G. L., et al. (2005). Design and methodology of the occluded artery trial (OAT). American Heart Journal, 150, 627–642.

    Article  Google Scholar 

  23. Ramjane, K., Han, L., & Jin, C. (2008). The diagnosis and treatment of the no-reflow phenomenon in patients with myocardial infarction undergoing percutaneous coronary intervention. Experimental and Clinical Cardiology, 13, 121–128.

    PubMed  PubMed Central  Google Scholar 

  24. Ardissino, D., Merlini, P. A., Bauer, K. A., et al. (2003). Coagulation activation and long-term outcome in acute coronary syndromes. Blood, 102, 2731–2735.

    Article  CAS  Google Scholar 

  25. Silvain, J., Collet, J. P., Nagaswami, C., et al. (2011). Composition of coronary thrombus in acute myocardial infarction. Journal of the American College of Cardiology, 57, 1359–1367.

    Article  Google Scholar 

  26. Limbruno, U., De Carlo, M., Pistolesi, S., et al. (2005). Distal embolization during primary angioplasty: histopathologic features and predictability. American Heart Journal, 150, 102–108.

    Article  Google Scholar 

  27. Undas, A., Szuldrzynski, K., Stepien, E., et al. (2008). Reduced clot permeability and susceptibility to lysis in patients with acute coronary syndrome: effects of inflammation and oxidative stress. Atherosclerosis, 196, 551–557.

    Article  CAS  Google Scholar 

  28. Becattini, C., Lignani, A., Masotti, L., Forte, M. B., & Agnelli, G. (2012). D-dimer for risk stratification in patients with acute pulmonary embolism. Journal of Thrombosis and Thrombolysis, 33, 48–57.

    Article  Google Scholar 

  29. Hochuli, M., Duewell, S., & Frauchiger, B. (2007). Quantitative D-dimer levels and the extent of venous thromboembolism in CT angiography and lower limb ultrasonography. Vasa, 36, 267–274.

    Article  CAS  Google Scholar 

  30. Jeebun, V., Doe, S. J., Singh, L., Worthy, S. A., & Forrest, I. A. (2010). Are clinical parameters and biomarkers predictive of severity of acute pulmonary emboli on CTPA? QJM, 103, 91–97.

    Article  CAS  Google Scholar 

  31. Ghanima, W., Abdelnoor, M., Holmen, L. O., et al. (2007). D-dimer level is associated with the extent of pulmonary embolism. Thrombosis Research, 120, 281–288.

    Article  CAS  Google Scholar 

  32. Kikkert, W. J., Claessen, B. E., Stone, G. W., et al. (2014). D-dimer levels predict ischemic and hemorrhagic outcomes after acute myocardial infarction: a horizons-ami biomarker substudy. Journal of Thrombosis and Thrombolysis, 37, 155–164.

    Article  CAS  Google Scholar 

  33. Pengo, V., Palareti, G., Cosmi, B., et al. (2008). D-dimer testing and recurrent venous thromboembolism after unprovoked pulmonary embolism: a post-hoc analysis of the prolong extension study. Thrombosis and Haemostasis, 100, 718–721.

    Article  CAS  Google Scholar 

  34. Verhovsek, M., Douketis, J. D., Yi, Q., et al. (2008). Systematic review: D-dimer to predict recurrent disease after stopping anticoagulant therapy for unprovoked venous thromboembolism. Annals of Internal Medicine, 149(481–490), W494.

    Google Scholar 

  35. Kearon, C., Spencer, F. A., O'Keeffe, D., et al. (2015). D-dimer testing to select patients with a first unprovoked venous thromboembolism who can stop anticoagulant therapy: a cohort study. Annals of Internal Medicine, 162, 27–34.

    Article  Google Scholar 

  36. Palareti, G., Cosmi, B., Legnani, C., et al. (2006). D-dimer testing to determine the duration of anticoagulation therapy. The New England Journal of Medicine, 355, 1780–1789.

    Article  CAS  Google Scholar 

  37. Kucher, N., Schroeder, V., & Kohler, H. P. (2003). Role of blood coagulation factor xiii in patients with acute pulmonary embolism. Correlation of factor xiii antigen levels with pulmonary occlusion rate, fibrinogen, D-dimer, and clot firmness. Thrombosis and Haemostasis, 90, 434–438.

    Article  CAS  Google Scholar 

  38. Yip, H. K., Chen, M. C., Chang, H. W., et al. (2002). Angiographic morphologic features of infarct-related arteries and timely reperfusion in acute myocardial infarction: predictors of slow-flow and no-reflow phenomenon. Chest, 122, 1322–1332.

    Article  Google Scholar 

  39. Yousef, Z. R., Redwood, S. R., Bucknall, C. A., Sulke, A. N., & Marber, M. S. (2002). Late intervention after anterior myocardial infarction: effects on left ventricular size, function, quality of life, and exercise tolerance: results of the open artery trial (toat study). Journal of the American College of Cardiology, 40, 869–876.

    Article  Google Scholar 

  40. Dzavik, V., Buller, C. E., Lamas, G. A., et al. (2006). Randomized trial of percutaneous coronary intervention for subacute infarct-related coronary artery occlusion to achieve long-term patency and improve ventricular function: the total occlusion study of Canada (TOSCA)-2 trial. Circulation, 114, 2449–2457.

    Article  Google Scholar 

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Acknowledgments

The authors would like to thank the research staff for their help.

Funding

This work was supported by the National Key Research and Development Program of China (2016YFC1301200) and the National Natural Science Foundation of China (81200170, 81870269, 81570223).

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Authors and Affiliations

  1. Department of Cardiology, DeltaHealth Hospital, Shanghai, China

    Xue Gong

  2. Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    Xue Gong, Zheyong Huang, Yanan Song, Qibing Wang, Juying Qian & Junbo Ge

  3. Department of Cardiology, No. 1 Hospital of Tianshui City, Tianshui, Gansu Province, China

    Xiaoting Lei

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Correspondence to Zheyong Huang or Junbo Ge.

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Human Subjects/Informed Consent Statement

No treatment was tested in patients by the authors for this article. Fudan University affiliated Zhongshan Hospital Ethics Committee had approved the work and received all the written informed consent.

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Associate Editor Craig M. Stolen oversaw the review of this article

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Gong, X., Lei, X., Huang, Z. et al. D-Dimer Level Predicts Angiographic No-Reflow Phenomenon After Percutaneous Coronary Intervention Within 2–7 Days of Symptom Onset in Patients with ST-Segment Elevation Myocardial Infarction. J. of Cardiovasc. Trans. Res. 14, 728–734 (2021). https://doi.org/10.1007/s12265-020-09991-6

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