Background: Data 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. Methods: Systematic 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. Results: Overall, 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. Conclusions: In 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 registration: The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews: CRD42021267233.

D-dimer for risk stratification and antithrombotic treatment management in acute coronary syndrome patients. asystematic review and metanalysis / Biccire, F. G.; Farcomeni, A.; Gaudio, C.; Pignatelli, P.; Tanzilli, G.; Pastori, D.. - In: THROMBOSIS JOURNAL. - ISSN 1477-9560. - 19:1(2021). [10.1186/s12959-021-00354-y]

D-dimer for risk stratification and antithrombotic treatment management in acute coronary syndrome patients. asystematic review and metanalysis

Biccire F. G.;Farcomeni A.;Gaudio C.;Pignatelli P.;Tanzilli G.;Pastori D.
2021

Abstract

Background: Data 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. Methods: Systematic 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. Results: Overall, 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. Conclusions: In 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 registration: The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews: CRD42021267233.
2021
acute coronary syndrome; D-dimer; myocardial infarction; no-reflow phenomenon; prognosis
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D-dimer for risk stratification and antithrombotic treatment management in acute coronary syndrome patients. asystematic review and metanalysis / Biccire, F. G.; Farcomeni, A.; Gaudio, C.; Pignatelli, P.; Tanzilli, G.; Pastori, D.. - In: THROMBOSIS JOURNAL. - ISSN 1477-9560. - 19:1(2021). [10.1186/s12959-021-00354-y]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1639294
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