D-dimer for risk stratification and antithrombotic treatment management in acute coronary syndrome patients: a systematic review and metanalysis

Thrombosis Journal

Pasquale Pignatelli¹  Daniele Pastori¹  Gaetano Tanzilli¹  Carlo Gaudio¹  Flavio Giuseppe Biccirè²  Alessio Farcomeni³ 

[1] Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy;Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy;Department of General and Specialized Surgery “Paride Stefanini”, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy;Department of Economics and Finance, University of Rome “Tor Vergata”, Via Columbia 2, 00133, Rome, Italy;

关键词: D-dimer;    Myocardial infarction;    No-reflow phenomenon;    Prognosis;    Acute coronary syndrome;   

DOI  :  10.1186/s12959-021-00354-y

来源: Springer

【 摘 要 】

BackgroundData on the prognostic role of D-dimer in patients with acute coronary syndrome (ACS) are controversial. Our aim was to summarize current evidence on the association between D-dimer levels and short/long-term poor prognosis of ACS patients. We also investigated the association between D-dimer and no-reflow phenomenon.MethodsSystematic review and metanalysis of observational studies including ACS patients and reporting data on D-dimer levels. PubMed and SCOPUS databases were searched. Data were combined with hazard ratio (HR) and metanalysed. The principal endpoint was a composite of cardiovascular events (CVEs) including myocardial infarction, all-cause and cardiovascular mortality.ResultsOverall, 32 studies included in the systematic review with 28,869 patients. Of them, 6 studies investigated in-hospital and 26 studies long-term outcomes. Overall, 23 studies showed positive association of high D-dimer levels with CVEs. D-dimer levels predicted poor prognosis in all studies reporting in-hospital outcomes. Five studies satisfied inclusion criteria and were included in the metanalysis, with a total of 8616 patients. Median follow-up was 13.2 months with 626 CVEs. The pooled HR for D-dimer levels and CVEs was 1.264 (95% CI 1.134–1.409). Five out of 7 studies (4195 STEMI patients) investigating the association between D-dimer levels and no-reflow showed a positive correlation of D-dimer levels with no-reflow.ConclusionsIn patients with ACS, D-dimer was associated with higher in-hospital and short/long-term complications. D-dimer was also higher in patients with no-reflow phenomenon. The use of D-dimer may help to identify patients with residual thrombotic risk after ACS.Trial registrationThe review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews: CRD42021267233.

【 授权许可】

CC BY