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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

Ling-Feng Gu1, Jie Gu1, Si-Bo Wang1, Hao Wang1, Ya-Xin Wang1, Yuan Xue1, Tian-Wen Wei1, Jia-Teng Sun1, Xiao-Qing Lian1, Jia-Bao Liu1, En-Zhi Jia1, Lian-Sheng Wang1
DOI: 10.5603/CJ.a2021.0097
·
Pubmed: 34490603
Affiliations
  1. the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, 210029 Nanjing, China

open access

Ahead of print
Original articles
Published online: 2021-08-17

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 was 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 (AUC) 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 was 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 (AUC) 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.

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Keywords

acute coronary syndrome, D-dimer, neutrophil to lymphocyte ratio, long-term outcome, percutaneous coronary intervention

Supp./Additional Files (3)
Supplemental Table 1: Univariate and multivariate COX regression analyses for predicting MACEs.
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Supplemental Table 2: Univariate and multivariate logistic regression analyses for predicting MACEs.
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Supplemental Figure 1: Kaplan-Meier survival curves in patients with ACS undergoing PCI. (A) according to the cut-off value of D-dimer; (B) according to the cut-off value of NLR. The median follow-up period was 40 months. For Figure 1A and 1B, P < 0.001.
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About this article
Title

Combination of D-dimer level and neutrophil to lymphocyte ratio predicts long-term clinical outcomes in acute coronary syndrome after percutaneous coronary intervention

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2021-08-17

DOI

10.5603/CJ.a2021.0097

Pubmed

34490603

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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