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. 2016 Aug 11;11(8):e0160955.
doi: 10.1371/journal.pone.0160955. eCollection 2016.

D-Dimer Levels Predict Myocardial Injury in ST-Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study

Soonuk Choi  1 , Woo Jin Jang  2 , Young Bin Song  1 , Joao A C Lima  3 , Eliseo Guallar  4 , Yeon Hyeon Choe  5 , Jin Kyung Hwang  1 , Eun Kyoung Kim  1 , Jeong Hoon Yang  1 , Joo-Yong Hahn  1 , Seung-Hyuk Choi  1 , Sang-Chol Lee  1 , Sang Hoon Lee  1 , Hyeon-Cheol Gwon  1
Affiliations

D-Dimer Levels Predict Myocardial Injury in ST-Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study

Soonuk Choi et al. PLoS One. .

Abstract

Objectives: Elevated D-dimer levels on admission predict prognosis in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), but the association of D-dimer levels with structural markers of myocardial injury in these patients is unknown.

Methods: We performed cardiac magnetic resonance (CMR) imaging in 208 patients treated with primary PCI for STEMI. CMR was performed a median of 3 days after the index procedure. Of the 208 patients studied, 75 patients had D-dimer levels above the normal range on admission (>0.5 μg/mL; high D-dimer group) while 133 had normal levels (≤0.5 μg/mL; low D-dimer group). The primary outcome was myocardial infarct size assessed by CMR. Secondary outcomes included area at risk (AAR), microvascular obstruction (MVO) area, and myocardial salvage index (MSI).

Results: In CMR analysis, myocardial infarct size was larger in the high D-dimer group than in the low D-dimer group (22.3% [16.2-30.5] versus 18.8% [10.7-26.7]; p = 0.02). Compared to the low D-dimer group, the high D-dimer group also had a larger AAR (38.1% [31.7-46.9] versus 35.8% [24.2-45.3]; p = 0.04) and a smaller MSI (37.7 [28.2-46.9] versus 47.1 [33.2-57.0]; p = 0.01). In multivariate analysis, high D-dimer levels were significantly associated with larger myocardial infarct (OR 2.59; 95% CI 1.37-4.87; p<0.01) and lower MSI (OR 2.62; 95% CI 1.44-4.78; p<0.01).

Conclusions: In STEMI patients undergoing primary PCI, high D-dimer levels on admission were associated with a larger myocardial infarct size, a greater extent of AAR, and lower MSI, as assessed by CMR data. Elevated initial D-dimer level may be a marker of advanced myocardial injury in patients treated with primary PCI for STEMI.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Scheme of Group Distribution.
AMI-CMR = acute myocardial infarction–cine magnetic resonance imaging; STEMI = ST-segment elevation myocardial infarction; NSTEMI = non ST-segment elevation myocardial infarction; PCI = percutaneous coronary intervention; CMR = cardiac magnetic resonance imaging.
Fig 2
Fig 2. Example Images From a Study of Reperfused Anterior ST-segment Elevation Myocardial Infarction.
Representative cardiac magnetic resonance images of a reperfused anterior ST-segment elevation myocardial infarction: (A) high D-dimer level with a short-axis slice of a T2-weighted image, (B) high D-dimer level with a late-gadolinium enhancement image, (C) low D-dimer level with a short-axis slice of a T2-weighted image, (D) low D-dimer level with a late-gadolinium enhancement image. In these cases, D-dimer levels, area at risk, and infarct size were 1.43μg/mL versus 0.26μg/mL, 72.2% versus 55.6% and 38.6% versus 17.9%, respectively, yielding a myocardial salvage index of 46.5 versus 67.8.
Fig 3
Fig 3. Cardiac Magnetic Resonance Findings According to D-dimer Level.
Boxplots shows cardiac magnetic resonance data according to D-dimer level and (A) myocardial infarct size, (B) area at risk, (C) myocardial salvage index, and (D) LVEF.
Fig 4
Fig 4. Linear regression analyses for Relationship Between Myocardial Injury, Level of D-dimer, and Age.
(A) Relationship between D-dimer level and infarct size. (B) Relationship between D-dimer level and myocardial salvage index. (C) Relationship between age and infarct size. (D) Relationship between age and myocardial salvage index.
See this image and copyright information in PMC

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