Objective: To investigate the association between postprocedural
D-dimer,
high sensitivity C-reactive protein(
hs-CRP) and
low-density lipoprotein-cholesterol(
LDL-C) and outcomes of acute
myocardial infarction (AMI) patients treated by
percutaneous coronary intervention(PCI), in order to clarify the impacts of thrombotic, inflammatory and
cholesterol risks on long-term prognosis. Methods: Patients with AMI who underwent emergency PCI from January 2010 to June 2017 in Fuwai Hospital with complete baseline data were enrolled. Patients were stratified into four groups according to quartiles of
D-dimer,
hs-CRP and LCL-C. Cox regression was used to analyze the relationship between these
biomarkers and prognosis. Restricted cubic spline (RCS) was used to characterize the continuous association between risk of all-cause death and
biomarkers. The primary outcome was all-cause death. Results: A total of 3 614 patients were included in the analysis. The age was (59.2±12.0) years old, and 2 845 (78.7%) were male and 3 161 (87.5%) patients were diagnosed as
ST-segment elevation myocardial infarction. The follow-up time was 652 (414, 1 880) days. Survival analysis showed that postprocedural
D-dimer and
hs-CRP were significantly associated with all-cause mortality (all P<0.05). Cox regression with multiple adjustments showed that patients with D-dimer≥580 μg/L presented higher risk of all-cause death (HR=2.03, 95%CI 1.22-3.38, P=0.006), compared to patients with
D-dimer<220 μg/L. RCS analysis showed that risk of all-cause death was stably high when
D-dimer reached 500 μg/L. Multivariable Cox regression also showed that patients with
hs-CRP<2.74 mg/L (HR=1.86, 95%CI 1.10-3.15, P=0.020)or hs-CRP≥11.99 mg/L (HR=2.14, 95%CI 1.35-3.40, P=0.001) presented higher mortality compared to patients whose
hs-CRP was 2.74-7.18 mg/L. RCS analysis indicated a J-shaped relation between
hs-CRP and mortality, as greater risk of death was observed when
hs-CRP was lower than 2 mg/L or higher than 10 mg/L.
LDL-C was not associated with outcomes (all P>0.05). Conclusions: Postprocedural
D-dimer is significantly associated with long-term prognosis of AMI patients treated by PCI. Patients with extremely high or low levels of
hs-CRP presents worse outcomes. Intensive and tailored antithrombotic or anti-inflammatory
therapies should be considered for patients with increased thrombotic risk and those with extremely high or low inflammatory risk.