Value of D-dimer combined with cystatin C in predicting the occurrence of major adverse cardiovascular events in patients with acute myocardial infarction undergoing percutaneous coronary intervention

doi:10.16138/j.1673-6087.2022.03.010

Abstract

Abstract:

Objective To investigate the predictive value of D-dimer combined with cystatin C level in the occurrence of major adverse cardiovascular event(MACE) in the patients with acute myocardial infarction. Methods From January 2014 to December 2017, 287 patients with acute myocardial infarction who received undergoing percutaneous coronary intervention (PCI) were selected. According to the median levels of serum D-dimer and cystatin C after admission, the patients were divided into four groups, group 1: D-dimer<0.33 mg/L, cystatin C<1.06 mg/L; group 2: D-dimer<0.33 mg/L, cystatin C≥1.06 mg/L; group 3: D-dimer≥0.33 mg/L, cystatin C<1.06 mg / L; group 4: D-dimer≥0.33 mg/L, cystatin C≥1.06 mg/L. The multivariate Cox regression analysis was used to analyze the value of D-dimer combined with cystatin C level in predicting the occurrence of MACE. Results The median time of follow up was 2.89 years. The multivariate Cox regression analysis showed that, the incidence of MACE was significantly increased in the group with high D-dimer and cystatin C levels [hazard ratio (HR)=2.71, 95% confidence interval (CI): 1.37-5.36, P<0.01] after adjustment of age, gender and traditional risk factors. Conclusions The D-dimer combined with cystatin C can effectively predict the occurrence of MACE in the patients with acute myocardial infarction undergoing PCI.

Key words: Acute myocardial infarction, Percutaneous coronary intervention, D-dimer, Cystatin C, Major adverse cardiovascular events

CLC Number:

R542.22

XI Rui, FAN Qin, WANG Fang, TAO Rong, GU Gang. Value of D-dimer combined with cystatin C in predicting the occurrence of major adverse cardiovascular events in patients with acute myocardial infarction undergoing percutaneous coronary intervention[J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(03): 227-232.

Figures/Tables 5

项目	D-二聚体		t/χ²	P	胱抑素C		t/χ²	P
项目	<0.33 mg/L（n=143）	≥0.33 mg/L（n=144）	t/χ²	P	<1.06 mg/L（n=144）	≥1.06 mg/L（n=143）	t/χ²	P
年龄(岁)	61.35±10.93	64.16±13.39	-1.95	0.05	58.32±12.26	67.23±10.61	-6.58	<0.01
男性	128 (89.5)	124 (86.1)	0.77	0.38	126 (87.5)	126 (88.1)	0.03	0.87
吸烟史[n(%)]	87 (60.8)	81 (56.3)	0.62	0.43	81 (56.3)	87 (60.8)	0.62	0.43
饮酒史[n(%)]	45 (31.5)	32 (22.2)	3.13	0.08	38 (26.4)	39 (27.3)	0.03	0.87
BMI （kg/m²）	24.58±3.22	24.42±3.34	0.41	0.68	24.71±3.32	24.29±3.23	1.09	0.28
收缩压（mmHg）	123.91±20.72	122.88±21.83	0.41	0.68	124.93±17.76	121.85±22.62	1.23	0.22
舒张压（mmHg）	74.94±13.06	73.27±12.80	1.10	0.27	75.42±13.47	72.78±12.27	1.73	0.09
心率（次/min）	78.41±12.97	79.04±14.55	-0.39	0.70	78.08±12.78	79.38±14.71	-0.80	0.42
既往史[n(%)]
高血压	95 (66.4)	99 (68.8)	0.18	0.68	87 (60.4)	107 (74.8)	6.80	0.01
糖尿病	38 (26.6)	46 (31.9)	1.00	0.32	51 (35.4)	33 (23.1)	5.28	0.02
肾功能不全	8 (5.6)	46 (31.9)	32.61	<0.01	1 (0.7)	53 (37.1)	62.13	<0.01
高脂血症	50 (35.0)	43 (29.9)	0.85	0.36	52 (36.1)	41 (28.7)	1.81	0.18
脑卒中	15 (10.5)	24 (16.7)	2.33	0.13	11 (7.6)	28 (19.6)	8.71	<0.01
超声心动图
LVEF（%）	56.83±9.37	49.11±11.34	6.29	<0.01	53.71±10.85	52.21±11.29	1.14	0.26
左心室舒张末期内径（mm）	52.18±5.52	54.74±5.87	-3.80	<0.01	53.13±5.07	53.80±6.51	-0.99	0.33
左心室收缩末期内径（mm）	36.00±6.12	40.07±7.08	-5.21	<0.01	37.59±6.46	38.50±7.35	-1.11	0.27
左心房内径（mm）	39.10±4.00	41.21±4.47	-4.21	<0.01	39.94±3.83	40.38±4.85	-0.85	0.39
实验室检查
白细胞（×10⁹/L）	8.54±2.79	8.79±3.42	-0.66	0.51	8.72±2.78	8.61±3.43	0.29	0.77
血红蛋白（g/L）	134.04±11.78	126.95±16.80	4.14	<0.01	132.71±12.80	128.24±16.53	2.56	0.01
血小板（×10⁹/L）	197.19±60.90	205.19±69.22	-1.04	0.3	209.59±66.95	192.76±62.53	2.20	0.03
空腹血糖（mmol/L）	5.71±1.56	6.35±3.60	-1.95	0.05	6.01±1.88	6.05±3.48	-0.12	0.90
糖化血红蛋白（%）	6.28±1.16	6.45±1.36	-1.09	0.28	6.60±1.48	6.14±0.97	3.08	<0.01
谷丙转氨酶（U/L）	38.87±26.24	55.97±70.94	-2.71	0.01	46.18±38.44	48.73±66.44	-0.40	0.69
白蛋白（g/L）	36.09±3.57	33.36±4.88	5.41	<0.01	35.72±3.87	33.71±4.83	3.89	<0.01
血肌酐（μmol/L）	81.59±16.24	111.11±118.32	-2.96	<0.01	75.65±12.73	117.29±117.32	-4.22	<0.01
尿酸（μmol/L）	343.43±87.06	338.63±133.60	0.36	0.72	307.86±89.84	374.41±123.29	-5.23	<0.01
eGFR[mL/ (min·1.73m²）]	84.72±18.44	72.07±24.86	4.90	<0.01	91.74±16.70	64.91±19.97	12.35	<0.01
总胆固醇（mmol/L）	4.20±0.99	4.17±1.07	0.31	0.75	4.33±0.99	4.04±1.05	2.40	0.02
三酰甘油（mmol/L）	1.79±1.17	1.42±0.60	3.30	<0.01	1.66±1.00	1.55±0.89	0.93	0.35
低密度脂蛋白（mmol/L）	2.64±0.86	2.58±0.94	0.63	0.53	2.77±0.89	2.45±0.89	3.02	<0.01
高密度脂蛋白（mmo/L）	1.01±0.41	0.91±0.25	2.41	0.02	1.00±0.42	0.93±0.23	1.84	0.07
CRP（mg/L）	16.22±26.39	41.87±65.38	-4.36	<0.01	18.72±31.68	39.55±64.07	-3.49	<0.01
NT-proBNP（ng/L）	1 513.35±1 974.10	3 470.74±4 763.06	-4.55	<0.01	1 469.95±1 889.16	3 528.12±4 790.10	-4.78	<0.01
高敏肌钙蛋白I（μg/L）	21.35±32.03	21.99±33.45	-0.17	0.87	19.85±32.06	23.51±33.34	-0.95	0.34
纤维蛋白原（g/L）	3.04±0.87	3.64±1.51	-4.10	<0.01	3.21±0.99	3.47±1.49	-1.70	0.09
纤维蛋白降解产物（mg/L）	1.20±0.96	4.28±5.02	-7.22	<0.01	2.45±3.94	3.04±3.92	-1.28	0.20
冠脉病变Gensini 评分(分)	54.83±34.01	55.71±35.17	-0.22	0.83	49.96±27.72	60.62±39.64	-2.64	0.01
用药情况[n(%)]
ACEI/ARB	105 (73.4)	99 (68.8)	0.76	0.38	96 (66.7)	108 (75.5)	2.74	0.10
β受体阻滞剂	125 (87.4)	121 (84.0)	0.67	0.41	122 (84.7)	124 (86.7)	0.23	0.63
硝酸酯类	62 (43.4)	64 (44.4)	0.03	0.85	62 (43.1)	64 (44.8)	0.08	0.77
他汀类	131 (91.6)	121 (84.0)	3.85	0.05	128 (88.9)	124 (86.7)	0.32	0.57

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项目	非校正	P	校正模型1	P	校正模型2	P
D-二聚体per SD	1.48 （1.24~1.78）	<0.01	1.46 （1.21~1.77）	<0.01	1.36 （1.11~1.66）	<0.01
D-二聚体<中位数	1（ref）		1（ref）		1（ref）
D-二聚体 ≥中位数	2.46 （1.58~3.83）	<0.01	2.40 （1.54~3.74）	<0.01	2.15 （1.34~3.45）	<0.01
胱抑素C per SD	1.48 （1.29~1.69）	<0.01	1.37 （1.18~1.58）	<0.01	1.34 （1.15~1.57）	<0.01
胱抑素C<中位数	1（ref）		1（ref）		1（ref）
胱抑素C≥中位数	2.00 （1.29~3.10）	<0.01	1.62 （1.03~2.54）	0.04	1.43 （0.88~2.31）	0.12

组别	非校正	P	HR（校正模型1）	P	HR（校正模型2）	P
组1	1（ref）		1（ref）		1（ref）
组2	1.80 （0.87~3.70）	0.11	1.73 （0.83~3.57）	0.14	1.69 （0.81~3.50）	0.16
组3	2.38 （1.19~4.77）	0.01	2.65 （1.32~5.32）	0.01	2.69 （1.33~5.43）	0.01
组4	4.18 （2.22~7.88）	<0.01	3.58 （1.86~6.86）	<0.01	2.71 （1.37~5.36）	<0.01