STEMI patients who fibrinolytic treatment value of D-dimer and fibrinogen levels in the manner of determining fibrinolysis failure.

İntroduction and Aim: Failure of fibrinolysis has been the most important reason of morbidity and mortality in ST-elevated myocardial infarction theraphy. So we need markers which can determine the failure of fibrinolysis in a short time period. Our study aimed to investigate the value of D-dimer levels, a marker of thrombosis and fibrinolysis in fibrinolytic patients and fibrinogen levels , a coagulation protein, in the manner of determining fibrinolysis failure.Methods: Between January 2007, and July 2008 ,we included 123 patients,between the age of 18 and 75 with written informed consents who attended in the Dokuz Eylül University Coronary Care Unit with the diagnosis of ST-elevated myocardial infarction and eligible for the fibrinolytic theraphy suggestions both clinically and ECG criteria according to ACC/AHA and ESC guidelines.The regression of ST elevation more than % 50 at 90 minutes inititaion of fibrinolytic theraphy had been used as reperfusion criteria.We collected venous blood samples before and after fibrinolytic theraphy to determine the relationship between fibrinolysis failure and D-dimer and fibrinogen levels.All patients have evaluated with transthoracic echocardiography and coronary angiography.Patients have evaluated in the manner of adverse cardiovascular events at 30 days after discharge.Findings: The difference of pre-treatment fibrinogen levels between the patients with fibrinolysis failure and patients with succesfull fibrinolysis is not statistically significant. (3.4 (SD = 1.2) g/L vs.3.7 (SD = 1.2 g/L)). The fall in fibrinogen levels with fibrinolytic theraphy is statistically significant in both group.(2.5 (SD=0.9) in failure group and 2.5 (SD=1.0) in succesfull group , p< 0.001). The mean level of pre ?treatment D-dimer is higher in the failure group than the succesfull group and this is statistically significant (2.9 SD = 2.6 µg/mL vs. 1.4 SD=1.7 µg/ mL p=0.001). Increase in D-dimer levels after fibrinolytic theraphy is statistically significant in succesfull group (p < 0.001) and not significant in failure group. (p = 0.076). According to Backward LR regression analysis the most important risk factors which affect the fibrinolytic theraphy failure are D-dimer levels higher than 0.9 µg/mL (p< 0.001 OR:5.9 % 95 CI:2.3-15.2) , myoglobin levels higher than 500 ng/mL (p=0.01 OR:3.5 % 95 CI:1.3-9.3), diabetes mellitus (p=0.019 OR:3.1 % 95 CI:1.2-7.8) and left ventricular ejection fraction under % 40 (p =0.035 OR:2.6 % 95 CI:1.1-6.2).Results: Relation between fibrinogen levels and failure of fibrinolysis was not determined.The pre-treatment D-dimer level is higher in failure group and it is statistically significant.The post-treatment D-dimer level is also higher in the succesfull group and it is statistically significant.Recently developed D-dimer tests can be used as easy and reliably markers which can determine the failure of fibrinolysis.Key words: ST elevated MI, Fibrinogen, D-dimer, Fibrinolytic theraphy, Primary Percutaneous Coronary Intervention