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

Hiroyuki Naruse, Junnichi Ishii, Hiroshi Takahashi, Fumihiko Kitagawa, Ryuunosuke Okuyama, Hideki Kawai, Takashi Muramatsu, Masahide Harada, Akira Yamada, Sadako Motoyama, Shigeru Matsui, Mutsuharu Hayashi, Masayoshi Sarai, Eiichi Watanabe, Hideo Izawa, Yukio Ozaki

Research output: Contribution to journalArticle

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Abstract

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. 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 modet alone. Conclusions: The combinatorial value of assessing D-dimer levels and eGFR may provide useful insight regarding stable CAD patients’ long-term risk stratification.

Original languageEnglish
Pages (from-to)1506-1513
Number of pages8
JournalCirculation Journal
Volume81
Issue number10
DOIs
Publication statusPublished - 01-01-2017

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Glomerular Filtration Rate
Coronary Artery Disease
Mortality
Atrial Fibrillation
Myocardial Infarction
fibrin fragment D
Chronic Renal Insufficiency
Cause of Death
Coronary Vessels
Pathologic Constriction
Outpatients
Biomarkers
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Naruse, Hiroyuki ; Ishii, Junnichi ; Takahashi, Hiroshi ; Kitagawa, Fumihiko ; Okuyama, Ryuunosuke ; Kawai, Hideki ; Muramatsu, Takashi ; Harada, Masahide ; Yamada, Akira ; Motoyama, Sadako ; Matsui, Shigeru ; Hayashi, Mutsuharu ; Sarai, Masayoshi ; Watanabe, Eiichi ; Izawa, Hideo ; Ozaki, Yukio. / 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. In: Circulation Journal. 2017 ; Vol. 81, No. 10. pp. 1506-1513.
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title = "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",
abstract = "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. 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 modet alone. Conclusions: The combinatorial value of assessing D-dimer levels and eGFR may provide useful insight regarding stable CAD patients’ long-term risk stratification.",
author = "Hiroyuki Naruse and Junnichi Ishii and Hiroshi Takahashi and Fumihiko Kitagawa and Ryuunosuke Okuyama and Hideki Kawai and Takashi Muramatsu and Masahide Harada and Akira Yamada and Sadako Motoyama and Shigeru Matsui and Mutsuharu Hayashi and Masayoshi Sarai and Eiichi Watanabe and Hideo Izawa and Yukio Ozaki",
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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. / Naruse, Hiroyuki; Ishii, Junnichi; Takahashi, Hiroshi; Kitagawa, Fumihiko; Okuyama, Ryuunosuke; Kawai, Hideki; Muramatsu, Takashi; Harada, Masahide; Yamada, Akira; Motoyama, Sadako; Matsui, Shigeru; Hayashi, Mutsuharu; Sarai, Masayoshi; Watanabe, Eiichi; Izawa, Hideo; Ozaki, Yukio.

In: Circulation Journal, Vol. 81, No. 10, 01.01.2017, p. 1506-1513.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 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

AU - Naruse, Hiroyuki

AU - Ishii, Junnichi

AU - Takahashi, Hiroshi

AU - Kitagawa, Fumihiko

AU - Okuyama, Ryuunosuke

AU - Kawai, Hideki

AU - Muramatsu, Takashi

AU - Harada, Masahide

AU - Yamada, Akira

AU - Motoyama, Sadako

AU - Matsui, Shigeru

AU - Hayashi, Mutsuharu

AU - Sarai, Masayoshi

AU - Watanabe, Eiichi

AU - Izawa, Hideo

AU - Ozaki, Yukio

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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. 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 modet alone. Conclusions: The combinatorial value of assessing D-dimer levels and eGFR may provide useful insight regarding stable CAD patients’ long-term risk stratification.

AB - 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. 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 modet alone. Conclusions: The combinatorial value of assessing D-dimer levels and eGFR may provide useful insight regarding stable CAD patients’ long-term risk stratification.

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U2 - 10.1253/circj.CJ-16-1272

DO - 10.1253/circj.CJ-16-1272

M3 - Article

C2 - 28539560

AN - SCOPUS:85030122499

VL - 81

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JO - Circulation Journal

JF - Circulation Journal

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