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Combination of D-dimer level and neutrophil to lymphocyte ratio predicts long-term clinical outcomes in acute coronary syndrome after percutaneous coronary intervention
Affiliations- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
open access
Abstract
Background: High D-dimer (DD) is associated with short-term adverse outcomes in patients with
acute coronary syndrome (ACS). In ACS patients who underwent percutaneous coronary intervention
(PCI), however, the value of DD (or combined with neutrophil to lymphocyte ratio [NLR]) to predict
long-term major adverse cardiovascular events (MACEs) has not been fully evaluated.
Methods: Patients diagnosed with ACS and receiving PCI were included. The primary outcome was
MACEs. Cox proportional hazards regression and logistic regression were used to illustrate the relationship
between clinical risk factors, biomarkers and MACEs. Survival models were developed based on
significant factors and evaluated by the Concordance-index (C-index).
Results: The final study cohort was comprised of 650 patients (median age, 64 years; 474 males),
including 98 (15%) with MACEs during a median follow-up period of 40 months. According to the
cut-off value of DD and NLR, the patients were separated into four groups: high DD or nonhigh DD
with high or nonhigh NLR. After adjusting for confounding variables, DD (adjusted hazard ratio
[aHR]: 2.39, 95% confidence interval [CI]: 1.52–3.76) and NLR (aHR: 2.71, 95% CI: 1.78–4.11) were
independently associated with long-term MACEs. Moreover, patients with both high DD and NLR had
a significantly higher risk in MACEs when considering patients with nonhigh DD and NLR as reference
(aHR: 6.19, 95% CI: 3.30–11.61). The area under curve increased and reached 0.70 in differentiating
long-term MACEs when DD and NLR were combined, and survival models incorporating the two
exhibited a stronger predictive power (C-index: 0.75).
Conclusions: D-dimer (or combined with NLR) can be used to predict long-term MACEs in ACS
patients undergoing PCI.
Abstract
Background: High D-dimer (DD) is associated with short-term adverse outcomes in patients with
acute coronary syndrome (ACS). In ACS patients who underwent percutaneous coronary intervention
(PCI), however, the value of DD (or combined with neutrophil to lymphocyte ratio [NLR]) to predict
long-term major adverse cardiovascular events (MACEs) has not been fully evaluated.
Methods: Patients diagnosed with ACS and receiving PCI were included. The primary outcome was
MACEs. Cox proportional hazards regression and logistic regression were used to illustrate the relationship
between clinical risk factors, biomarkers and MACEs. Survival models were developed based on
significant factors and evaluated by the Concordance-index (C-index).
Results: The final study cohort was comprised of 650 patients (median age, 64 years; 474 males),
including 98 (15%) with MACEs during a median follow-up period of 40 months. According to the
cut-off value of DD and NLR, the patients were separated into four groups: high DD or nonhigh DD
with high or nonhigh NLR. After adjusting for confounding variables, DD (adjusted hazard ratio
[aHR]: 2.39, 95% confidence interval [CI]: 1.52–3.76) and NLR (aHR: 2.71, 95% CI: 1.78–4.11) were
independently associated with long-term MACEs. Moreover, patients with both high DD and NLR had
a significantly higher risk in MACEs when considering patients with nonhigh DD and NLR as reference
(aHR: 6.19, 95% CI: 3.30–11.61). The area under curve increased and reached 0.70 in differentiating
long-term MACEs when DD and NLR were combined, and survival models incorporating the two
exhibited a stronger predictive power (C-index: 0.75).
Conclusions: D-dimer (or combined with NLR) can be used to predict long-term MACEs in ACS
patients undergoing PCI.
Keywords
acute coronary syndrome, D-dimer, neutrophil to lymphocyte ratio, long-term outcome, percutaneous coronary intervention
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About this articleTitle
Combination of D-dimer level and neutrophil to lymphocyte ratio predicts long-term clinical outcomes in acute coronary syndrome after percutaneous coronary intervention
Journal
Issue
Article type
Original Article
Pages
576-586
Published online
2021-08-17
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1623
Article views/downloads
758
DOI
Pubmed
Bibliographic record
Cardiol J 2023;30(4):576-586.
Keywords
acute coronary syndrome
D-dimer
neutrophil to lymphocyte ratio
long-term outcome
percutaneous coronary intervention
Authors
Ling-Feng Gu
Jie Gu
Si-Bo Wang
Hao Wang
Ya-Xin Wang
Yuan Xue
Tian-Wen Wei
Jia-Teng Sun
Xiao-Qing Lian
Jia-Bao Liu
En-Zhi Jia
Lian-Sheng Wang
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