Baseline D-Dimer Levels as a Risk Assessment Biomarker for Recurrent Stroke in Patients with Combined Atrial Fibrillation and Atherosclerosis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Subjects
2.2. Ethics Statement
2.3. Protocol and Outcome Measurements
2.4. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Clinical Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Patients with D-Dimer Levels of < 2.0 μg/mL (n = 926) | Patients with D-Dimer Levels of ≥ 2.0 μg/mL (n = 515) | Total (n = 1441) | p Value | |
---|---|---|---|---|
Age, years (mean ± SD) | 73.6 ± 9.6 | 73.2 ± 9.8 | 73.5 ± 9.7 | 0.454 |
Male, n (%) | 475 (51.3) | 275 (53.4) | 750 (52.0) | 0.477 |
Valvular AF, n (%) | 23 (2.5) | 8 (1.6) | 31 (2.2) | 0.328 |
AF type, n (%) | <0.001 | |||
Paroxysmal AF | 578 (62.4) | 260 (50.5) | 838 (58.2) | |
Sustained AF | 348 (37.6) | 255 (49.5) | 603 (41.8) | |
Body mass index | 23.2 ± 3.3 | 23.4 ± 3.4 | 23.3 ± 3.3 | 0.465 |
History of Risk Factors, n (%) | ||||
Hypertension | 650 (70.2) | 376 (73.0) | 1026 (71.2) | 0.284 |
Diabetes mellitus | 268 (28.9) | 142 (27.6) | 410 (28.5) | 0.623 |
Dyslipidemia | 217 (23.4) | 96 (18.6) | 313 (21.7) | 0.041 |
Congestive heart failure | 34 (3.7) | 22 (4.3) | 56 (3.9) | 0.673 |
Current smoking | 142 (15.3) | 62 (12.0) | 204 (14.2) | 0.101 |
Prior stroke or TIA | 276 (29.8) | 178 (34.6) | 454 (31.5) | 0.071 |
Biochemical Variables (mean ± SD) | ||||
D-dimer, μg/mL | 0.8 ± 0.5 | 6.1 ± 6.5 | 2.7 ± 4.6 | <0.001 |
LDL-C, mg/dL | 98.4 ± 33.9 | 97.6 ± 34.6 | 98.1 ± 34.1 | 0.708 |
Triglyceride, mg/dL | 99.4 ± 63.1 | 92.4 ± 48.2 | 96.9 ± 58.3 | 0.019 |
HDL-C, mg/dL | 48.3 ± 19.2 | 47.0 ± 17.1 | 47.8 ± 18.5 | 0.186 |
Glycated hemoglobin, % | 6.1 ± 2.0 | 5.9 ± 1.0 | 6.0 ± 1.7 | 0.078 |
Admission glucose, mg/dL | 139.2 ± 81.2 | 137.8 ± 48.5 | 138.7 ± 71.2 | 0.687 |
Creatinine clearance, mL/min | 65.6 ± 28.0 | 56.3 ± 27.8 | 62.3 ± 28.3 | <0.001 |
Pre-stroke mRS, median (IQR) | 0 (0;1) | 0 (0;2) | 0 (0; 1) | 0.054 |
Initial NIHSS, median (IQR) | 6 (2;13) | 13 (6;18) | 9 (2; 15) | <0.001 |
Intravenous alteplase, n (%) | 159 (17.2) | 168 (32.6) | 327 (22.7) | <0.001 |
Mechanical thrombectomy, n (%) | 120 (13.0) | 87 (16.9) | 207 (14.4) | 0.050 |
CHA2DS2-VASc score, median (IQR) | 5 (4; 6) | 5 (4;6) | 5 (4;6) | 0.001 |
CHA2DS2-VASc ≥ 5, n (%) | 552 (59.6) | 372 (72.2) | 924 (64.1) | <0.001 |
AIS presumed arterial origin, n (%) | 276 (29.8) | 162 (31.5) | 438 (30.4) | 0.553 |
Large Artery Atherosclerosis, n (%) | ||||
Carotid atherosclerosis | 260 (31.7) | 154 (32.7) | 414 (32.1) | 0.772 |
Intracranial atherosclerosis | 648 (78.0) | 314 (65.4) | 962 (73.4) | <0.001 |
Coronary atherosclerosis | 144 (15.6) | 69 (13.4) | 213 (14.8) | 0.305 |
Peripheral atherosclerosis | 13 (1.4) | 8 (1.6) | 21 (1.5) | 1.000 |
Transthoracic Echocardiographic Findings * | ||||
LA thrombus, n (%) | 11 (1.3) | 11 (2.3) | 22 (1.7) | 0.259 |
LA volume index, mL/m2 | 66.0 ± 24.8 | 67.0 ± 24.9 | 66.3 ± 24.8 | 0.493 |
LVEF < 50%, n (%) | 122 (14.5) | 74 (15.6) | 196 (14.9) | 0.677 |
LV diastolic dysfunction, n (%) | 596 (71.2) | 343 (72.3) | 939 (71.6) | 0.727 |
Moderate–severe AR, n (%) | 9 (1.1) | 13 (2.7) | 22 (1.7) | 0.042 |
Moderate–severe MR, n (%) | 26 (3.1) | 23 (4.9) | 49 (3.8) | 0.149 |
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Choi, K.-H.; Seo, W.-K.; Park, M.-S.; Kim, J.-T.; Chung, J.-W.; Bang, O.Y.; Kim, G.-M.; Song, T.-J.; Kim, B.J.; Heo, S.H.; et al. Baseline D-Dimer Levels as a Risk Assessment Biomarker for Recurrent Stroke in Patients with Combined Atrial Fibrillation and Atherosclerosis. J. Clin. Med. 2019, 8, 1457. https://doi.org/10.3390/jcm8091457
Choi K-H, Seo W-K, Park M-S, Kim J-T, Chung J-W, Bang OY, Kim G-M, Song T-J, Kim BJ, Heo SH, et al. Baseline D-Dimer Levels as a Risk Assessment Biomarker for Recurrent Stroke in Patients with Combined Atrial Fibrillation and Atherosclerosis. Journal of Clinical Medicine. 2019; 8(9):1457. https://doi.org/10.3390/jcm8091457
Chicago/Turabian StyleChoi, Kang-Ho, Woo-Keun Seo, Man-Seok Park, Joon-Tae Kim, Jong-Won Chung, Oh Young Bang, Geong-Moon Kim, Tae-Jin Song, Bum Joon Kim, Sung Hyuk Heo, and et al. 2019. "Baseline D-Dimer Levels as a Risk Assessment Biomarker for Recurrent Stroke in Patients with Combined Atrial Fibrillation and Atherosclerosis" Journal of Clinical Medicine 8, no. 9: 1457. https://doi.org/10.3390/jcm8091457