Impact of D-Dimer on the Prognostic Value of PARIS Thrombosis Risk Score in Acute Coronary Syndrome Patients Undergoing PCI: From a Large Prospective Cohort Study.

BACKGROUND: Guideline-recommended PARIS thrombotic risk score predicts coronary thrombosis events (CTE) in Acute Coronary Syndrome (ACS) patients undergoing Percutaneous Coronary Intervention. We aim to evaluate whether D-dimer, a thrombotic biomarker, can predict long-term adverse events and improve the prognostic value of PARIS score.

METHODS AND RESULTS: This is a post-hoc analysis on a prospective cohort of 10,724 Chinese patients undergoing PCI. Patients who presented as ACS were included and stratified according to baseline D-dimer level (cutoff 0.28 µg/mL). The primary endpoint is all-cause death. Secondary endpoints are cardiac death and CTE. A total of 5139 ACS patients with PCI were analyzed, 2735 patients had D-dimer ≥ 0.28 µg/mL, while 2404 patients had D-dimer < 0.28 µg/mL. After adjusting for confounders, patients with higher D-dimer had significantly higher risk of 5-year all-cause death (HR = 1.951, 95% CI: 1.366-2.787) and cardiac death (HR = 2.513, 95% CI: 1.574-4.012), whilst a trend toward higher risk of 5-year CTE (HR = 1.285, 95% CI: 0.956-1.729) was observed. Compared with PARIS score alone, adding D-dimer to the model increased the area under the receiver operating characteristic curve on 5-year all-cause death (0.663-0.701, p = 0.006) and cardiac death (0.652-0.699, p = 0.015), both with significant net reclassification improvement (p < 0.001).

CONCLUSION: In our cohort of ACS patients undergoing PCI, D-dimer independently predicts long-term all-cause death and cardiac death, and improves the predictive value of PARIS score over 5-year all-cause death and cardiac death.