The Value of d-Dimer Level in Predicting Contrast-Induced Acute Kidney Injury in Patients With Acute ST-Segment Elevation Myocardial Infarction After PCI.
The Value of d-Dimer Level in Predicting Contrast-Induced Acute Kidney Injury in Patients With Acute ST-Segment Elevation Myocardial Infarction After PCI.
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d-二聚体水平在预测 PCI 术后急性 ST 段抬高型心肌梗死患者对比剂诱发的急性肾损伤中的价值。
DOI：
10.1177/1076029620944492
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发表时间：
2020-01
期刊：
影响因子：
--
通讯作者：
Tang C
中科院分区：
文献类型：
--
作者：
Luo E;Wang D;Liu B;Hou J;Yan G;Tang C
造影剂诱导的急性肾损伤（CI-AKI）是急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）的严重并发症。早期识别高危患者对预防CI-AKI至关重要。本研究旨在评价血栓形成和高凝状态标志物d-二聚体对ST段抬高型心肌梗死患者CI-AKI和预后的预测价值。我们纳入了400例接受PCI的STEMI患者。采用4分位数法，根据d-二聚体水平将患者分为4组。66例（16.5%）患者发生造影剂诱导的急性肾损伤。D-二聚体最高四分位数组的CI-AKI发生率（29.0%）高于其他3组。多变量logistic回归分析显示，低d-二聚体水平与CI-AKI风险降低显著相关，不受混杂因素影响，第一四分位数与最高四分位数相比，比值比（OR）为0. 487（95% CI：0. 178 - 0. 931，P = 0. 041）。年龄（OR：1.047，95% CI：1.003-1.092）、糖尿病（OR：5.896，95% CI：2.496-13.927）、贫血（OR：3.488，95% CI：1.308-9.306）和总胆红素（OR：0.946，95% CI：0.904-0.992）是CI-AKI的独立预测因子。PCI术后30 d、6个月、1年主要心脑血管不良事件发生率及全因死亡率，D-二聚体最高四分位数组均高于其他3组。总之，增加的d-二聚体水平与PCI后STEMI患者的CI-AKI发生率和不良结局独立相关。
Contrast-induced acute kidney injury (CI-AKI) is a serious complication of percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Early identification of high-risk patients has an essential role in preventing CI-AKI. This study was designed to evaluate the predictive value of d-dimer, a marker of thrombosis and hypercoagulable state, for CI-AKI and prognosis in patients with STEMI. We included 400 patients with STEMI who underwent PCI. The patients were subdivided into 4 groups according to d-dimer level using the 4-quantile method. Contrast-induced acute kidney injury occurred in 66 (16.5%) patients. The incidence of CI-AKI in the highest quartile of the d-dimer groups (29.0%) was higher than that in the other 3 groups. Multivariable logistic regression showed that a low d-dimer level was significantly associated with a decreased risk of CI-AKI independent of confounding factors, with an odds ratio (OR) of 0.487 (95% CI: 0.178-0.931, P = 0.041) for those in the first quartile compared with those in the highest quartile. Age (OR: 1.047, 95% CI: 1.003-1.092), diabetes mellitus (OR: 5.896, 95% CI: 2.496-13.927), anemia (OR: 3.488, 95% CI: 1.308-9.306), and total bilirubin (OR: 0.946, 95% CI: 0.904-0.992) were independent predictors of CI-AKI. The incidence of major adverse cardiovascular and cerebral events and all-cause mortality within 30 days, 6 months, and 1 year after PCI in the highest quartile of the d-dimer groups were higher than those in the other 3 groups. In conclusion, increasing d-dimer levels were independently associated with the incidence of CI-AKI and adverse outcomes in patients with STEMI after PCI.
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