Imaging Challenges in Diagnosing Triple-Negative Breast Cancer.

Triple-negative breast cancer (TNBC) refers to a heterogeneous group of carcinomas that have more aggressive biologic features, faster growth, and a propensity for early distant metastasis and recurrence compared with other breast cancer subtypes. Due to the aggressiveness and rapid growth of TNBCs, there are specific imaging challenges associated with their timely and accurate diagnosis. TNBCs commonly manifest initially as circumscribed masses and therefore lack the typical features of a primary breast malignancy, such as irregular shape, spiculated margins, and desmoplastic reaction. Given the potential for misinterpretation, review of the multimodality imaging appearances of TNBCs is important for guiding the radiologist in distinguishing TNBCs from benign conditions. Rather than manifesting as a screening-detected cancer, TNBC typically appears clinically as a palpable area of concern that most commonly corresponds to a discrete mass at mammography, US, and MRI. The combination of circumscribed margins and hypoechoic to anechoic echogenicity may lead to TNBC being misinterpreted as a benign fibroadenoma or cyst. Therefore, careful mammographic and sonographic evaluation with US image optimization can help avoid misinterpretation. Radiologists should recognize the characteristics of TNBCs that can mimic benign entities, as well as the subtle features of TNBCs that should raise concern for malignancy and aid in timely and accurate diagnosis. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Pregnancy management and outcome after uterus transplantation.

Uterus transplantation is a novel approach in women whose uterus is absent or severely abnormal. However, it is still an experimental procedure that poses risks to both mother and baby. To date, 32 live births after uterus transplantation have been reported in peer-reviewed journals, with several maternal, fetal and neonatal complications. The most common complications were preterm delivery, hypertensive disorders and placenta previa. Four patients experienced episodes of transplant rejection during pregnancy. The appropriate management of complicated and non-complicated pregnancies following uterus transplantation is still unresolved. In this review, obstetric outcomes after uterus transplantation and optimal management during pregnancy are discussed in light of the available data. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Outcome of Imaging and Biopsy of BI-RADS Category 3 Lesions: Follow-Up Compliance, Biopsy, and Malignancy Rates in a Large Patient Cohort.

OBJECTIVES: To identify biopsy rates and indications for BI-RADS 3 lesions in a large cohort of patients and compare with follow-up compliance and malignancy outcomes. METHODS: We retrospectively reviewed all BI-RADS category-3 lesions seen on mammography and/or ultrasound between 2013 and 2015. Patient age, lesion size, follow-up rates at 6-, 12-, and 24-months were collected. Biopsy timing, indication, and outcomes (malignant vs benign) were recorded using at least 2-year follow-up or biopsy pathology as endpoint. RESULTS: Of 2319 BI-RADS 3 lesions in 2075 women analyzed, biopsy was performed in 173 (7.5%). Most biopsies were performed upfront (99, 57.2%), followed by at 6 (44, 25.4%), 12 (21, 12.1%), and 24-month follow-up (9, 5.2%; P < .001). Palpable (P < .001) and larger (median 1.4 vs 1.0 cm, P < .001) lesions in women <40 years (15.2% vs 4.8%, P < .001) were more likely to undergo biopsy. Most biopsies were prompted by patient/physician desire (64.5%, P < .001). Of 783 lesions with available endpoint, 5 (0.6%) were cancer. All cancers were identified either at presentation (in 0-5 months, n = 1) or 6-month follow-up (in 5-9 months, n = 4) with biopsy prompted by either morphology change (n = 3) or lesion growth (n = 2). Of the 1855 lesions which were expected for follow up, only 310 (16.7%) underwent all follow-ups, while 482 (26.1%) had two, 489 (26.5%) one, and 565 (30.6%) had no follow-up. CONCLUSIONS: In our cohort, BI-RADS category 3 lesions had significantly higher biopsy rates compared with the small malignancy rate, all of which were identified at baseline or first follow-up. Overall patient follow-up compliance low. Imaging follow-up, especially at first 6-month time point, should be encouraged in BI-RADS 3 lesions, instead of upfront biopsies.

Performance of a clinical and imaging-based multivariate model as decision support tool to help save unnecessary surgeries for high-risk breast lesions.

PURPOSE: To investigate the performance of an imaging and biopsy parameters-based multivariate model in decreasing unnecessary surgeries for high-risk breast lesions. METHODS: In an IRB-approved study, we retrospectively reviewed all high-risk lesions (HRL) identified at imaging-guided biopsy in our institution between July 1, 2014-July 1, 2017. Lesions were categorized high-risk-I (HR-I = atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ and atypical papillary lesion) and II (HR-II = Flat epithelial atypia, radial scar, benign papilloma). Patient risk factors, lesion features, detection and biopsy modality, excision and cancer upgrade rates were collected. Reference standard for upgrade was either excision or at least 2-year imaging follow-up. Multiple logistic regression analysis was performed to develop a multivariate model using HRL type, lesion and biopsy needle size for surgical cancer upgrade with performance assessed using ROC analysis. RESULTS: Of 699 HRL in 652 patients, 525(75%) had reference standard available, and 48/525(9.1%) showed cancer at surgical excision. Excision (84.5% vs 51.1%) and upgrade (17.6%vs1.8%) rates were higher in HR-I compared to HR-II (p < 0.01). In HR-I, small needle size < 12G vs ≥ 12G [32.1% vs 13.2%, p < 0.01] and less cores [< 6 vs ≥ 6, 28.6%vs13.7%, p = 0.01] were significantly associated with higher cancer upgrades. Our multivariate model had an AUC = 0.87, saving 28.1% of benign surgeries with 100% sensitivity, based on HRL subtype, lesion size(mm, continuous), needle size (< 12G vs ≥ 12G) and biopsy modality (US vs MRI vs stereotactic) CONCLUSION: Our multivariate model using lesion size, needle size and patient age had a high diagnostic performance in decreasing unnecessary surgeries and shows promise as a decision support tool.

Effects of two types of energy restriction on methylation levels of adiponectin receptor 1 and leptin receptor overlapping transcript in a mouse mammary tumour virus-transforming growth factor-α breast cancer mouse model.

The role of adiponectin and leptin signalling pathways has been suggested to play important roles in the protective effects of energy restriction (ER) on mammary tumour (MT) development. To study the effects of ER on the methylation levels in adiponectin receptor 1 (AdipoR1) and leptin receptor overlapping transcript (Leprot) genes using the pyrosequencing method in mammary fat pad tissue, mouse mammary tumour virus-transforming growth factor-α (MMTV-TGF-α) female mice were randomly assigned to ad libitum (AL), chronic ER (CER, 15 % ER) or intermittent ER (3 weeks AL and 1 week 60 % ER in cyclic periods) groups at 10 weeks of age until 82 weeks of age. The methylation levels of AdipoR1 in the CER group were higher than those in the AL group at week 49/50 (P < 0·05), while the levels of methylation for AdipoR1 and Leprot genes were similar among the other groups. Also, the methylation levels at CpG2 and CpG3 regions of the promoter region of the AdipoR1 gene in the CER group were three times higher (P < 0·05), while CpG1 island of Leprot methylation was significantly lower compared with the other groups (P < 0·05). Adiponectin and leptin gene expression levels were consistent with the methylation levels. We also observed a change with ageing in methylation levels of these genes. These results indicate that different types of ER modify methylation levels of AdipoR1 and Leprot in different ways and CER had a more significant effect on methylation levels of both genes. Epigenetic regulation of these genes may play important roles in the preventive effects of ER against MT development and ageing processes.

Psycho-social impact of malocclusion in adolescents in Kosovo.

OBJECTIVE: To assess the psychosocial impact of malocclusion, establish its association with the severity of malocclusion and determine the effects of gender and age in such association. BASIC RESEARCH DESIGN: Cross-sectional study. METHODS: 400 adolescents aged between 12-15 years were randomly selected. Each participant was examined for malocclusion and categorized according to Index of Orthodontic Treatment Need (IOTN) and Dental Aesthetic Index (DAI). The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) was used to assess the psychosocial impact of malocclusion. RESULTS: Significant differences were noted between PIDAQ subscales, and grades of malocclusion assessed by IOTN and DAI (p⟨0.05). Gender differences were noted in Dental Self Confidence (DSC), Social Impact (SI) and Psychological Impact (PI) for the same severity of malocclusion (p⟨0.05). IOTN-DHC predicted the total and subscales of PIDAQ scores. Gender and age were the independent predictive variables of the relationship between the PIDAQ scores and the IOTN-DHC grades for the DSC and AC subscales. Gender independently predicted psychological impact. CONCLUSION: Severity of malocclusion, gender and age were related to impacts on the psychosocial wellbeing of participants. Overall, females and older participants experienced worse psychosocial impact.

Contrast-Enhanced Digital Mammography: Technique, Clinical Applications, and Pitfalls.

OBJECTIVE. Contrast-enhanced digital mammography (CEDM) combines the high spatial resolution of mammography with the improved enhancement provided by contrast medium. In this article, CEDM technique-the current and potential clinical applications and current challenges-will be reviewed. CONCLUSION. CEDM is a promising technique in the supplemental evaluation of patients with mammographically inconclusive findings and potentially in the screening of women with mammographically dense breasts. CEDM is emerging as a cost-effective alternative to dynamic contrast-enhanced MRI to stage newly diagnosed breast cancer and evaluate response to neoadjuvant chemotherapy.

Treatment of severely decayed anterior primary teeth with short-post technique (Mushroom Restorations) under general anesthesia.

AIMS: The aim of this study was to evaluation the treatment success of the short post technique (mushroom restoration) using a composite resin in severely decayed primary anterior teeth after 6, 12, and 18 months after treatment. METHODS: Eighteen children aged 3-5 years with severely decayed primary maxillary anterior teeth (60 anterior maxillary primary teeth in total) were included. Patients were treated under general anesthesia (GA). After pulpectomy, a "mushroom shape" was formed in the root canals for the purpose of retention, and the root canals were filled with zinc oxide-eugenol (ZOE), and the teeth were restored with composite resin. The status of treatment was evaluated clinically and radiographically for periapical radiolucency, pathological root resorption, marginal fracture, and loss of restoration for each treated tooth. All findings were recorded. RESULTS: As a result of the evaluation criteria, the success rates at 6, 12 and 18 months were 86%, 80%, and 71%, respectively. None of the teeth showed apical radiolucency or pathological root resorption at the end of the 18th month period. CONCLUSION: The short-post (mushroom restorations) technique is a clinically acceptable alternative method for restoration of severely decayed primary teeth. This study supports the feasibility of treatment with this technique for pediatric patients treated under GA.

T-cell bispecific antibodies in node-positive breast cancer: novel therapeutic avenue for MHC class I loss variants.

BACKGROUND: Tumor-infiltrating lymphocytes (TILs) represent a prognostic factor for survival in primary breast cancer (BC). Nonetheless, neoepitope load and TILs cytolytic activity are modest in BC, compromising the efficacy of immune-activating antibodies, which do not yet compete against immunogenic chemotherapy. PATIENTS AND METHODS: We analyzed by functional flow cytometry the immune dynamics of primary and metastatic axillary nodes [metastatic lymph nodes (mLN)] in early BC (EBC) after exposure to T-cell bispecific antibodies (TCB) bridging CD3ε and human epidermal growth factor receptor 2 (HER2) or Carcinoembryonic Antigen-Related Cell Adhesion Molecule 5 (CEACAM5), before and after chemotherapy. Human leukocyte antigen (HLA) class I loss was assessed by whole exome sequencing and immunohistochemistry. One hundred primary BC, 64 surrounding 'healthy tissue' and 24 mLN-related parameters were analyzed. RESULTS: HLA loss of heterozygosity was observed in EBC, at a clonal and subclonal level and was associated with regulatory T cells and T-cell immunoglobulin and mucin-domain-3 expression restraining the immuno-stimulatory effects of neoadjuvant chemotherapy. TCB bridging CD3ε and HER2 or CEACAM5 could bypass major histocompatibility complex (MHC) class I loss, partially rescuing T-cell functions in mLN. CONCLUSION: TCB should be developed in BC to circumvent low MHC/peptide complexes.

Interleukin-32 levels in gingival crevicular fluid and saliva of patients with chronic periodontitis after periodontal treatment.

BACKGROUND AND OBJECTIVE: The cytokine, interleukin (IL)-32, is a relatively new discovery. However, it is very powerful for stimulating tumor necrosis factor-alpha (TNF-α) under inflammatory conditions. The objective of this research was to explore fluctuations in the levels of TNF-α, IL-32 and IL-10, in both saliva and gingival crevicular fluid. The focus was on measurements taken before and after clinical treatment of chronic periodontitis. MATERIAL AND METHODS: For the purposes of the study, a total of 27 patients with chronic periodontitis and 27 controls (periodontally healthy) were recruited. Important clinical periodontal criteria were established before and 4 wk after the start of the research. The chronic periodontitis group was given an initial form of periodontal care. Samples of saliva and gingival crevicular fluid were collected exactly 4 wk preceding and 4 wk following the care. The levels of IL-10, IL-32 and TNF-α present in saliva and gingival crevicular fluid were recorded via the use of an ELISA. RESULTS: At baseline, the levels of TNF-α and IL-32 in the gingival crevicular fluid and saliva were significantly higher among patients in the chronic periodontitis group than among patients in the control group (p < 0.05). On the other hand, at baseline the levels of IL-10 were significantly lower in the gingival crevicular fluid and saliva of the chronic periodontitis group than the control group (p < 0.05). A significantly positive link was found between the TNF-α and IL-32 levels in the two study groups (p < 0.05). After treatment, the levels of TNF-α and IL-32 in saliva and gingival crevicular fluid were significantly lower in the chronic periodontitis group when compared with the baseline readings. However, the levels of IL-10 were significantly higher (p < 0.05). CONCLUSION: Ultimately, the level of IL-32 present in saliva and gingival crevicular fluid might be useful as an indicator of the condition and the expectations for its treatment and care. According to the results of the research, the proinflammatory impact of IL-32 could potentially be linked to the intensity and progression of periodontitis.

Quality of life after thyroid surgery.

PURPOSE: The purpose of this study was to inquire how patients' quality of life is affected after thyroid surgery and the factors involved. METHODS: A semi-structured questionnaire and the World Health Organization Quality of Life Scale (WHOQOL-BREF) were applied to 101 patients prior to surgery. Thereafter data was collected in the early and again in the late post-operative period. RESULTS: Mean general health score for pre-operative quality of life was 6.72 ± 1.53 (3-10), mean physical field score was 22.81 ± 2.77 (17-31), mean psychological field score was 21.69 ± 2.78 (15-28), mean social field score was 11.10 ± 1.94 (5-15) and mean environmental field score was 27.86 ± 4.30 (18-39). In the early post-operative period, mean general health score was 7.05 ± 1.45 (4-10), mean physical field score was 22.84 ± 2.83 (14-29), mean psychological field score was 21.67 ± 2.32 (16-27), mean social field score was 10.89 ± 1.96 (5-15) and mean environmental field score was 28.56 ± 4.18 (18-40). In the late post-operative period, the general health score for quality of life was 7.43 ± 1.34 (4-10), mean physical field score was 23.59 ± 2.70 (17-35), mean psychological field score was 21.75 ± 2.34 (14-29), mean social field score was 11.23 ± 1.94 (6-15) and mean on-field environment score was 29.30 ± 3.96 (16-40). The pre-operative levels of symptoms were found to be higher than early and late post-operative periods. CONCLUSIONS: Quality of life increased after total thyroidectomy and statistically significant improvement was observed in late post-operative stage.

Parental beliefs and practices regarding childhood fever in Turkish primary care.

BACKGROUND: Fever is a very common problem in pediatric age and is one of the most common reasons parents seek medical attention. We aimed to investigate beliefs, habits, and concerns of Turkish parents regarding their children's fever. MATERIALS AND METHODS: We performed a cross-sectional survey which was conducted as face-to-face interviews by family physicians from April to June 2014 in family healthcare centers in nine different cities in Turkey. Parents with a child with fever aged between 0 and 14 years were interviewed. The participants were asked questions about sociodemographic data, the definition and measurement of fever, antipyretics, and other interventions used to reduce fever before presenting to the primary care center. RESULTS: A total of 205 parents participated in this study. Ninety-four parents (45.8%) measured fever with a thermometer prior to presentation. Only 36 parents (38%) used the thermometer correctly. Thirty-eight parents (18.5%) knew the correct temperature definition of fever for the measured site. A mercury-in-glass thermometer was the choice for most parents (78%) and preferred site for measurement was axillary region (85%). The fever was treated prior to arrival by 171 parents (83.4%). Paracetamol was the most frequently used antipyretic. Fifty-four parents (31.5%) failed to administer the correct antipyretic dose, and 73 parents (42.6%) failed to give the antipyretics at proper intervals. One hundred and fifty-three parents (67%) believed that if not treated fever could cause convulsions. CONCLUSION: We conclude that parents share important misconceptions about definition, treatment, and consequences of childhood fever and tend to treat fever before seeking medical care with a substantial rate of wrong doses and wrong intervals.

A phase II study of axitinib (AG-013736) in patients with incurable adenoid cystic carcinoma.

BACKGROUND: Recurrent/metastatic adenoid cystic carcinoma (ACC) is an incurable disease with no standard treatments. The majority of ACCs express the oncogenic transcription factor MYB (also c-myb), often in the context of a MYB gene rearrangement. This phase II trial of the tyrosine kinase inhibitor (TKI) axitinib (Pfizer) tested the hypothesis that targeting pathways activated by MYB can be therapeutically effective for ACC. PATIENTS AND METHODS: This is a minimax two-stage, phase II trial that enrolled patients with incurable ACC of any primary site. Progressive or symptomatic disease was required. Patients were treated with axitinib 5 mg oral twice daily; dose escalation was allowed. The primary end point was best overall response (BOR). An exploratory analysis correlating biomarkers to drug benefit was conducted, including next-generation sequencing (NGS) in 11 patients. RESULTS: Thirty-three patients were registered and evaluable for response. Fifteen patients had the axitinib dose increased. Tumor shrinkage was achieved in 22 (66.7%); 3 (9.1%) had confirmed partial responses. Twenty-five (75.8%) patients had stable disease, 10 of whom had disease stability for >6 months. The median progression-free survival (PFS) was 5.7 months (range 0.92-21.8 months). Grade 3 axitinib-related toxicities included hypertension, oral pain and fatigue. A trend toward superior PFS was noted with the MYB/NFIB rearrangement, although this was not statistically significant. NGS revealed three tumors with 4q12 amplification, producing increased copies of axitinib-targeted genes PDGFR/KDR/KIT. Two 4q12 amplified patients achieved stable disease for >6 months, including one with significant tumor reduction and the longest PFS on study (21.8 months). CONCLUSIONS: Although the primary end point was not met, axitinib exhibited clinical activity with tumor shrinkage achieved in the majority of patients with progressive disease before trial enrollment. Analysis of MYB biomarkers and genomic profiling suggests the hypothesis that 4q12 amplified ACCs are a disease subset that benefit from TKI therapy.

What hides behind the MASC: clinical response and acquired resistance to entrectinib after ETV6-NTRK3 identification in a mammary analogue secretory carcinoma (MASC).

BACKGROUND: Mammary analogue secretory carcinoma (MASC) is a recently described pathologic entity. We report the case of a patient with an initial diagnosis of salivary acinic cell carcinoma later reclassified as MASC after next-generation sequencing revealed an ETV6-NTRK3 fusion. PATIENTS AND METHODS: This alteration was targeted with the pan-Trk inhibitor entrectinib (Ignyta), which possesses potent in vitro activity against cell lines containing various NTRK1/2/3 fusions. RESULTS: A dramatic and durable response was achieved with entrectinib in this patient, followed by acquired resistance that correlated with the appearance of a novel NTRK3 G623R mutation. Structural modeling predicts that this alteration sterically interferes with drug binding, correlating to decreased sensitivity to drug inhibition observed in cell-based assays. CONCLUSIONS: This first report of clinical activity with TrkC inhibition and the development of acquired resistance in an NTRK3-rearranged cancer emphasize the utility of comprehensive molecular profiling and targeted therapy for rare malignancies (NCT02097810).

Glutathione levels in plasma, saliva and gingival crevicular fluid after periodontal therapy in obese and normal weight individuals.

BACKGROUND AND OBJECTIVE: The purpose of this study was to investigate the effects of obesity on reduced and oxidized glutathione (GSH and GSSG) levels in the gingival crevicular fluid, plasma and saliva of patients with chronic periodontitis and to evaluate the changes after nonsurgical periodontal therapy. MATERIAL AND METHODS: The study included 60 patients: 30 patients with chronic periodontitis (15 obese patients and 15 normal weight patients) and 30 healthy control subjects (15 obese patients and 15 normal weight patients). Gingival crevicular fluid, plasma and saliva samples were collected, and clinical periodontal measurements were recorded at baseline and at the first month after periodontal therapy from patients with chronic periodontitis. GSH and GSSG levels were analyzed with spectrophotometry. RESULTS: The GSH levels in the plasma, saliva and gingival crevicular fluid in obese individuals with chronic periodontitis were lower than in normal weight individuals at baseline (p < 0.01). There was a significant difference in the GSH/GSSG ratio in plasma and gingival crevicular fluid between the obese and normal weight groups at baseline (p < 0.01). The GSH levels in plasma, gingival crevicular fluid and saliva were significantly increased in both chronic periodontitis groups after nonsurgical periodontal therapy (p < 0.01). A significant positive correlation was found between GSH levels in saliva, plasma and gingival crevicular fluid in all groups (p < 0.001). CONCLUSIONS: The study revealed that obesity in patients with chronic periodontitis is associated with decreased GSH levels and the GSH/GSSG ratio. Moreover, nonsurgical periodontal therapy may be helpful for improvement in glutathione values in obese and normal weight individuals with chronic periodontitis.

Chemerin and interleukin-6 levels in obese individuals following periodontal treatment.

OBJECTIVE: To investigate changes in the levels of gingival crevicular fluid (GCF) chemerin and interleukin-6 (IL-6) in both obese/non-obese individuals with periodontitis following non-surgical periodontal therapy. METHODS: Individuals (n = 80) were split into four groupings according to periodontal/anthropometric parameters: (i) periodontal healthy without obesity; (ii) chronic periodontitis (CP) without obesity; (iii) periodontal healthy with obesity; and (iv) CP with obesity. Individuals with periodontitis were treated with non-surgical periodontal therapy. Both GCF sampling procedures and clinical periodontal measures were performed prior to treatment and 6 weeks thereafter. Enzyme-linked immunosorbent assay was utilized to measure both chemerin and IL-6 levels. RESULTS: Greater values for chemerin and IL-6 were observed in obese individuals compared to their non-obese controls and in individuals with CP compared to their periodontal healthy controls (P < 0.008), which decreased following therapy (P < 0.05). A positive correlation was found between chemerin and IL-6 in obese groups (P < 0.05). A comprehensive overview of all groups showed a statistically significant positive correlation among chemerin, along with IL-6, waist-to-hip ratio, body mass index, and clinical attachment levels (P < 0.05). CONCLUSION: It could be concluded that chemerin levels may act as both diagnostic and prognostic indicators. Chemerin may also play an integral part in the pathologic mechanisms that relate adipokines to both periodontal disease and obesity.

[Fatal aortarupture following electroconvulsive therapy]. / Aortaruptuur als fatale complicatie bij elektroconvulsietherapie.

Electroconvulsive therapy (ect) is a highly effective and safe form of treatment in psychiatry. However, fatal cardiovascular complications are rarely discussed in the literature. We describe the case of a 49-year old man who died from a ruptured aorta following treatment with ect.

Impact of D-dimer level on postinterventional coronary flow and in-hospital MACE in ST-segment elevation myocardial infarction.

OBJECTIVE: Preintervention thrombus burden in the infarct-related artery is an independent predictor of no-reflow and adverse outcomes in coronary artery disease. The role of D-dimers in the acute phase of ST-elevated myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) has not been fully elucidated. We aimed to investigate the predictive value of serum D-dimer levels on the outcome of patients with STEMI. METHODS AND RESULTS: A total of 266 consecutive patients presenting with STEMI within the first 12 h of symptom onset were included in this study. Patients were divided into two groups based on the postinterventional Thrombolysis In Myocardial Infarction (TIMI) flow grade score. Postinterventional TIMI grades of 0, 1, or 2 were defined as no-reflow (group 1) and angiographic success was defined as TIMI 3 flow (group 2). D-dimer levels were significantly higher in patients with postinterventional no-reflow than in patients with postinterventional TIMI grade 3 flow (686 ± 236 µg/ml-418 ± 164 µg/ml, p < 0.001). Multivariate logistic regression analysis showed that D-dimer level was an independent predictor of postinterventional no-reflow (OR: 1.005; 95 % CI: 1.003-1.007; p < 0.001) and in-hospital major adverse cardiovascular events (MACE; OR: 1.002; 95 % CI: 1.000-1.004; p = 0.029). Receiver operator characteristics analysis provided a cut-off value of 549 µg/ml for D-dimer for predicting no-reflow with an 83 % sensitivity and an 81 % specificity, and 544 µg/ml for predicting in-hospital MACE with a 69 % sensitivity and a 67 % specificity. CONCLUSION: In conclusion, D-dimer levels measured on admission may be an independent predictor of no-reflow, which is also a predictor of adverse outcomes in patients with STEMI.