D-dimer is useful in assessing the vulnerable blood in elderly patients with coronary disease

Background and objective The value of D-dimer in the risk stratification of patients with coronary artery disease(CAD) and the relationship between D-dimer and the diseased coronary arteries remains controversial or unclear, especially in the elderly. This study was to evaluate the usefulness of D-dimer as a biomarker in assessing the vulnerable blood in the elderly patients with coronary disease. Methods Sixty elderly (≥60 years old) male patients with suspected CAD were enrolled in this prospective study. Patients were divided into CAD group (n=41, 10 with stable angina and 31 with unstable angina) and control group (n=19) according to their coronary angiography Results Clinical information including age, body mass index (BMI), smoking index, and the complications of primary hypertension or diabetes, and CAD family history was collected. Venous blood was sampled serially for the determination of total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, apoA1, apoB, glucose, uric acid, homocysteine (Hcy), hs-CRP, soluble thrombomodulin (sTM), and markers of fibrinolytic system and hypercoagulability, such as D-dimer, fibrinogen, etc. The extent of coronary atherosclerosis was assessed, using the Gensini scoring system on the basis of coronary angiography. Results Compared with the controls, the patients with CAD had significantly higher levels of D-dimer. D-dimer level was significantly correlated to age, hs-CRP, Hcy, and PAI-1. Patients with D-dimer levels in the top triplicate of D-dimer level had significantly higher prevalence of unstable angina compared with patients in the lowest triplicate (OR=4.8, Z=3.28, P=0.001). In an ordinal logistic regression, the OR value of developing more serious CAD augmented 3.1-fold with each increasing triplicate of D-dimer. Patients with unstable angina had a significantly higher level of D-dimer than the controls (P=0.005), and an increasing trend compared with patients with stable angina (P=0.059), whereas there was no difference between the patients with stable angina and the controls (P=0.885). D-dimer was significantly correlated with Gensini scores (r=0.3930, P=0.0019). Ordinal logistic regression showed that the OR value of increasing one or two triplicates of Gensini’s scores augmented 1.44-fold with each increasing triplicate of D-dimer (OR=2. 44, Z=2.87, P=0.004). Conclusions D-dimer may be a helpful biomarker in identifying the severity of vulnerable blood in elderly patients with CAD.