Abstract
INTRODUCTION: To determine the association of d-dimer levels with in-hospital death and coronary artery disease (CAD) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). METHODS: We retrospectively analyzed the data of 803 NSTEACS patients admitted to Beijing Anzhen Hospital between January 2022 and January 2024. Demographic, clinical, and laboratory data were compared between survivors (792 patients) and non-survivors (11 patients). Risk factors for in-hospital death were analyzed. The cutoff plasma d-dimer level was determined using the Youden index to predict in-hospital death in patients with NSTEACS, and the rates of in-hospital mortality and multi-vessel CAD (2-vessel + 3-vessel disease) were compared between patients with high (103 patients) and low d-dimer levels (700 patients). RESULTS: D-dimer [odds ratio (OR): 1.003, p = 0.033, 95% confidence interval (CI): 1.000-1.006], Global Registry of Acute Coronary Events score (OR: 3.174, p < 0.001, 95% CI: 1.686-5.977), multi-vessel CAD (OR: 6.118, p = 0.013, 95% CI: 1.468-25.499), and Thrombolysis in Myocardial Infarction score (OR: 1.060, p = 0.002, 95% CI: 1.022-1.099) were independently associated with in-hospital death. The area under the receiver operating characteristic curve of d-dimer was 0.781 (p = 0.001, 95% CI: 0.634-0.927). The maximum Youden index was 0.607, with a cutoff of 504 ng/mL distinguishing high and low risk of in-hospital death in NSTEACS patients. In-hospital mortality (8/103 vs. 3/700, p < 0.001) and multi-vessel CAD rates (47/103 vs. 222/700, p = 0.003) were higher in the high d-dimer group. CONCLUSION: The higher the d-dimer level in NSTEACS patients, the higher the risk of in-hospital death and the higher the probability of multi-vessel CAD. D-dimer levels were significantly associated with in-hospital death and multi-vessel CAD in NSTEACS patients.