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30-Oct-2001
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Arch Hellen Med, 2000, 17(Supplement):133-136
ORIGINAL PAPER
Fibrin degradation products (D-dimers) in acute myocardial infarction
E. SINIORAKIS, K. PATRIS, C. BRINIAS, P. TSONOU, S.
ARVANITAKIS, P. BONORIS
Department of Cardiology, “Elpis” General
Municipal Hospital, Athens, Greece
OBJECTIVE To check if the detection of D-dimers
(DD) in patients (pts) with acute myocardial infarction (AMI) is a prognostic
marker of increased morbidity and in-hospital mortality.
METHOD Eighty-seven consecutive pts (M/F=54/33,
mean age=67±12 years) were enrolled. Pts with commorbidities which could affect
blood coagulation, were excluded. Plasma DD were evaluated on admission, before
administration of any drastic therapy, by semiquantitative method (FDP-Slidex
bioMerieux), and daily ever since. Thirty-eight pts with positive DD were included
in group A, while group B consisted of 49 pts with negative DD. All pts received
aspirin and low molecular weight (LMW) heparin, while 30 pts who were thrombolysed
received intravenous heparin for 5 days and LMW form subsequently. For every
subject, demographics, peak troponin I, Killip Class of heart failure in the
frst day, major arrhythmias, and mortality were recorded. The above parameters
were compared between the two groups by the t-test and chi-square, and P<0.05
was considered as statistically significant.
RESULTS Demographics, peak troponin I and Killip
stage were similar in the two groups. Despite that, group A presented a fourfold
increase in episodes of paroxysmal atrial fibrillarion (AF) between days 2–5,
and a fourfold increase in mortality due to heart failure. Thrombolysis and
heparin administration did not modify DD. Similarly, pharmacological and/or
electrical conversion of AF did not change the original classifcation of pts.
CONCLUSIONS Detection of DD in pts with AMI, suggests
a hypercoagulability which can be expressed later under form of AF and heart
failure. Thrombolysis, heparin, and cardioversion do not affect DD production.
Late heart failure causes a high mortality, and cannot be predicted by classic
prognostic markers. Pts with AMI and positive DD constitute a high risk group
and warrant increased vigillance.
Key words: Atrial fibrillation, Fibrin degradation, Mortality, Myocardial infarction.
