D-Dimer to Creatinine Ratio (DCR) and Intracoronary Thrombus Burden as Risk Factors for Hospitalized Major Cardiovascular Events (MACE) in Patients with ST Elevation Myocardial Infarction (STEMI)
Achmad Ismail Sampurna Putra*, I Made Junior Rina Artha, and I Kadek Susila Surya Darma
Abstract
Background: STEMI pathophysiology is based on increased activity of coagulation, thrombosis, and inflammation. The role of STEMI biomarkers is essential for prognostic and risk stratification. Dimer-Creatinine Ratio (DCR) is a novel biomarker that could be combined with intracoronary thrombus burden according to TIMI Thrombus Grade to evaluate in hospital MACE in STEMI patients. Methods: A cohort prospective design was implemented in this study, with subjects of STEMI patients undergoing primary PCI. Low and high DCR values were determined by the ROC curve. Survival analysis with the Kaplan-Meier curve was used to evaluate MACE outcome according to DCR and intracoronary thrombus burden. Multivariate analysis Cox regression and stratification analysis were used to evaluate independent risk factors, the relationship of each variable, and in hospital MACE. Results: A total of 60 samples were included, 40 patients (66.7%) with high DCR and 36 patients (60%) with high intracoronary thrombus burden. 36 (59.8%) patients were known to have in hospital MACE. Cut-off point was used to determine high DCR was 1.51 (AUC 0.905; 95%CI: 0.825-0.989; p<0.001). Cox regression model backward log rank showed high DCR (adjusted HR 20.81; 95%CI: 2.18-98.16; p=0.007) and high intracoronary thrombus burden (adjusted HR 31.38; 95%CI: 4.51-89.15; p=0.017), smoking (adjusted HR 2.70; 95% CI 0.88-3.29; p=0.012), and diabetes mellitus (adjusted HR 7.55; 95% CI 1.13-11.58; p=0.035) played a role as independent risk factors of in-hospital MACE in STEMI patients. A combination of both high DCR and high intracoronary thrombus burden had a higher incidence of 91.2% of in hospital MACE according to stratification analysis (Mantel-Haenzel Common Estimate 14.33; Breslow-Day Homogeneity p=0.803; Cochran’s and Mantel-Haenszel p=<0.013). Conclusion: High DCR and high intracoronary thrombus burden can be used as additional information for risk stratification of in hospital MACE in STEMI patients, especially when both parameters are combined.
Keywords
STEMI; D Dimer-Creatinine Ratio (DCR); intracoronary thrombus burden; Major Adverse Cardiovascular Events (MACE); cardiovascular death; cardiogenic shock; acute heart failure; malignant arrhythmia
Cite This Article
Putra, A. I. S., Artha, I. M. J. R., Darma, I. K. S. S. (2023). D-Dimer to Creatinine Ratio (DCR) and Intracoronary Thrombus Burden as Risk Factors for Hospitalized Major Cardiovascular Events (MACE) in Patients with ST Elevation Myocardial Infarction (STEMI). International Journal of Scientific Advances (IJSCIA), Volume 4| Issue 6: Nov-Dec 2023, Pages 920-936, URL: https://www.ijscia.com/wp-content/uploads/2023/11/Volume4-Issue6-Nov-Dec-No.526-920-936.pdf
Volume 4 | Issue 6: Nov-Dec 2023
