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Original research
D-dimer and the incidence of heart failure and mortality after acute myocardial infarction
  1. Xiaoyuan Zhang1,2,
  2. Shanjie Wang1,2,
  3. Jinxin Liu1,2,
  4. Yini Wang1,
  5. Hengxuan Cai1,2,
  6. Duolao Wang3,
  7. Shaohong Fang2,
  8. Bo Yu1,2
  1. 1 Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
  2. 2 Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China
  3. 3 Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
  1. Correspondence to Professor Bo Yu, Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin 150086, China; dryu_hmu{at}


Objective D-dimer might serve as a marker of thrombogenesis and a hypercoagulable state following plaque rupture. Few studies explore the association between baseline D-dimer levels and the incidence of heart failure (HF), all-cause mortality in an acute myocardial infarction (AMI) population. We aimed to explore this association.

Methods We enrolled 4504 consecutive patients with AMI with complete data in a prospective cohort study and explored the association of plasma D-dimer levels on admission and the incidence of HF, all-cause mortality.

Results Over a median follow-up of 1 year, 1112 (24.7%) patients developed in-hospital HF, 542 (16.7%) patients developed HF after hospitalisation and 233 (7.1%) patients died. After full adjustments for other relevant clinical covariates, patients with D-dimer values in quartile 3 (Q3) had 1.51 times (95% CI 1.12 to 2.04) and in Q4 had 1.49 times (95% CI 1.09 to 2.04) as high as the risk of HF after hospitalisation compared with patients in Q1. Patients with D-dimer values in Q4 had more than a twofold (HR 2.34; 95% CI 1.33 to 4.13) increased risk of death compared with patients in Q1 (p<0.001). But there was no association between D-dimer levels and in-hospital HF in the adjusted models.

Conclusions D-dimer was found to be associated with the incidence of HF after hospitalisation and all-cause mortality in patients with AMI.

  • acute myocardial infarction
  • heart failure

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  • XZ and SW contributed equally.

  • BY and SF contributed equally.

  • Contributors XZ and SW were responsible for the concept, analysis and drafting of the manuscript, and take responsibility for the integrity of the data. All authors were involved in delivery of this prospective cohort study, contributed to analysis of the data and provided important critical revision of the manuscript.

  • Funding This work was supported by National Key R&D Program of China (No. 2016YFC1301100) and Major Instrument Development Project of National Natural Science Foundation of China (No. 81827806). SF was supported by National Natural Science Foundation of China (No. 81870353).

  • Competing interests None declared.

  • Patient and public involvement statement Patients or the public were not involved in the design, conduct or dissemination plans of our study.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Ethics Committee of Harbin Medical University and was performed in accordance with the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. The data are available from the correspondence authors.