Prognostic Value of Combination of Plasma D-Dimer Concentration and Estimated Glomerular Filtration Rate in Predicting Long-Term Mortality of Patients With Stable Coronary Artery Disease

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  • Naruse Hiroyuki
    Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine
  • Ishii Junnichi
    Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine
  • Takahashi Hiroshi
    Division of Statistics, Fujita Health University School of Medicine
  • Kitagawa Fumihiko
    Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine
  • Okuyama Ryuunosuke
    Department of Cardiology, Fujita Health University School of Medicine
  • Kawai Hideki
    Department of Cardiology, Fujita Health University School of Medicine
  • Muramatsu Takashi
    Department of Cardiology, Fujita Health University School of Medicine
  • Harada Masahide
    Department of Cardiology, Fujita Health University School of Medicine
  • Yamada Akira
    Department of Cardiology, Fujita Health University School of Medicine
  • Motoyama Sadako
    Department of Cardiology, Fujita Health University School of Medicine
  • Matsui Shigeru
    Department of Cardiology, Fujita Health University School of Medicine
  • Hayashi Mutsuharu
    Department of Cardiology, Banbuntane Houtokukai Hospital
  • Sarai Masayoshi
    Department of Cardiology, Fujita Health University School of Medicine
  • Watanabe Eiichi
    Department of Cardiology, Fujita Health University School of Medicine
  • Izawa Hideo
    Department of Cardiology, Banbuntane Houtokukai Hospital
  • Ozaki Yukio
    Department of Cardiology, Fujita Health University School of Medicine

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<p>Background:A modestly elevated circulating D-dimer level may be relevant to coronary artery disease (CAD), but its prognostic value, both independently and in combination with estimated glomerular filtration rate (eGFR), for long-term death has not been fully evaluated in stable CAD patients.</p><p>Methods and Results:Baseline plasma D-dimer levels and eGFR were measured in 1,341 outpatients (mean age: 65 years) with prior myocardial infarction (MI), coronary revascularization, and/or angiographic evidence of a significant stenosis (>50%) for at least one of the major coronary arteries. Among these patients, 43% had prior MI, 47% had prior coronary revascularization, 41% had multivessel CAD, 14% had paroxysmal or persistent atrial fibrillation, 32% had diabetes, and 32% had chronic kidney disease (eGFR <60 mL/min/1.73 m2). D-dimer levels weakly correlated with eGFR (r=−0.25; P<0.0001). During a mean follow-up period of 73 months, there were 124 deaths, including 61 cardiovascular deaths. Multivariate Cox regression analysis identified D-dimer levels (P=0.001) and eGFR (P=0.006) as independent predictors of all-cause death. Adding both D-dimer and eGFR to a baseline model with established risk factors improved the net reclassification (P<0.005) and integrated discrimination improvement (P<0.05) greater than that of any single biomarker or baseline model alone.</p><p>Conclusions:The combinatorial value of assessing D-dimer levels and eGFR may provide useful insight regarding stable CAD patients’ long-term risk stratification.</p>

Journal

  • Circulation Journal

    Circulation Journal 81 (10), 1506-1513, 2017

    The Japanese Circulation Society

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