Abstract 14535: Elevated Levels of D-Dimer Predict Adverse Outcomes in Patients With Nonvalvular Atrial Fibrillation at Low-Intermediate Risk
Background: In patients with atrial fibrillation (AF), there is no clear consensus about risk prediction or antithrombotic treatment at low-intermediate risk stratified by clinical variables. Elevated levels of D-dimer could be predictive of adverse events in AF patients.
Methods: Plasma levels of D-dimer, CHADS2 and CHA2DS2VASc score, incidences of cardiovascular (CV) events (stroke, myocardial infarction or admission for heart failure) and mortality were evaluated in 263 patients with nonvalvular AF (mean age 67 years, 198 men, mean follow-up 5.3±3.0 years) who underwent transesophageal echocardiography for evaluation of cardioembolic risk.
Results: D-dimer >0.7 (median) μ g/ml, independently of CHADS2 score >2, predicted CV mortality (Hazard ratio (HR) 3.0, p<0.05 and HR 3.9, p<0.01, respectively), CV events (HR 2.1, p<0.01 and HR 2.4, p<0.01, respectively) and ischemic stroke (HR 3.5, p<0.05 and HR 2.2, p=0.12, respectively). Among patients with CHADS2 score =0 or 1 (n=131), CV mortality, CV events and stroke were higher in patients with D-dimer >0.7μ g/ml than in those with D-dimer <0.7μ g/ml (1.5 vs 0.2%/years, p<0.05; 4.5 vs 1.7%/years, p<0.05; 1.7 vs 0.4%/years, p=0.07; respectively). D-dimer >0.7μ g/ml, irrespective of clinical variables, predicted CV events (HR 2.5, p<0.05) even among patients with CHADS2 score =0 or 1. Among patients with CHA2DS2VASc score =0 or 1 (n=56), D-dimer levels were elevated (>0.7μ g/ml) in 14 patients (25%), and the incidences of events in patients with D-dimer >0.7 and <0.7μ g/ml were as follows: CV mortality (1.0 vs 0.4%/years), CV events (3.2 vs 1.5%/years) and stroke (1.0 vs 0.7%/years).
Conclusions: Elevated levels of D-dimer, independently of clinical variables, predicted CV mortality, CV events and stroke. In patients with nonvalvular AF at low-intermediate risk, measurement of D-dimer could be useful to detect patients who should receive anticoagulation treatment.
- © 2011 by American Heart Association, Inc.