Combination of D-dimer level and neutrophil to lymphocyte ratio predicts long-term clinical outcomes in acute coronary syndrome after percutaneous coronary intervention

Background: High D-dimer (DD) is associated with short-term adverse outcomes in patients withacute coronary syndrome (ACS). In ACS patients who underwent percutaneous coronary intervention(PCI), however, the value of DD (or combined with neutrophil to lymphocyte ratio [NLR]) to predictlong-term major adverse cardiovascular events (MACEs) has not been fully evaluated. Methods: Patients diagnosed with ACS and receiving PCI were included. The primary outcome wasMACEs. Cox proportional hazards regression and logistic regression were used to illustrate the relationshipbetween clinical risk factors, biomarkers and MACEs. Survival models were developed based onsignificant factors and evaluated by the Concordance-index (C-index). Results: The final study cohort was comprised of 650 patients (median age, 64 years; 474 males),including 98 (15%) with MACEs during a median follow-up period of 40 months. According to thecut-off value of DD and NLR, the patients were separated into four groups: high DD or nonhigh DDwith high or nonhigh NLR. After adjusting for confounding variables, DD (adjusted hazard ratio[aHR]: 2.39, 95% confidence interval [CI]: 1.52–3.76) and NLR (aHR: 2.71, 95% CI: 1.78–4.11) wereindependently associated with long-term MACEs. Moreover, patients with both high DD and NLR hada significantly higher risk in MACEs when considering patients with nonhigh DD and NLR as reference(aHR: 6.19, 95% CI: 3.30–11.61). The area under curve increased and reached 0.70 in differentiatinglong-term MACEs when DD and NLR were combined, and survival models incorporating the twoexhibited a stronger predictive power (C-index: 0.75). Conclusions: D-dimer (or combined with NLR) can be used to predict long-term MACEs in ACSpatients undergoing PCI