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Red cell distribution width (RDW) as a predictor of long-term mortality in patients undergoing percutaneous coronary
Shyam Poludasu1, Jonathan D Marmur, Jeremy Weedon
1Division of Cardiology, Department of Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203-2098, USA.
Insights
High red cell distribution width (RDW) predicts mortality in patients after percutaneous coronary intervention (PCI), especially those without anemia. This finding highlights RDW
Area of Science:
- Cardiology
- Hematology
Background:
- Red cell distribution width (RDW) is an established mortality predictor in coronary artery disease and heart failure.
- The prognostic value of RDW in patients undergoing percutaneous coronary intervention (PCI) requires further investigation.
Purpose of the Study:
- To evaluate the prognostic utility of RDW in predicting long-term mortality in patients who underwent PCI.
- To explore the interaction between RDW and hemoglobin (Hgb) levels in this patient cohort.
Main Methods:
- Retrospective analysis of 859 patients undergoing PCI between January 2003 and August 2005.
- RDW categorized into low, medium, and high groups using empirically determined cutoffs (13.3% and 15.7%).
- Multivariate analysis assessing the independent predictive value of RDW for mortality, considering interactions with Hgb levels.
Main Results:
- A total of 95 (11%) deaths occurred during a median follow-up of 4 years.
- Higher RDW was a significant univariate predictor of mortality (p < 0.001).
- RDW was not an independent predictor in patients with Hgb <10.4 g/dL. However, in patients with Hgb >10.4 g/dL, high RDW strongly predicted mortality (HR 5.2-8.6 compared to low RDW).
Conclusions:
- RDW is a strong and independent predictor of long-term mortality in non-anemic patients undergoing PCI.
- The prognostic impact of RDW is significantly influenced by baseline hemoglobin levels.
- RDW may serve as a valuable risk stratification tool in patients post-PCI.
Abstract:
Red cell distribution width (RDW) has been shown to be an independent predictor of mortality in patients with coronary artery disease and in patients with heart failure. The current study evaluated the prognostic utility of RDW in patients undergoing percutaneous coronary intervention (PCI). We evaluated 859 patients who underwent PCI during January 2003 to August 2005. After a median follow up of four (interquartile range 3.1 to 4.4) years, there were a total of 95 (11%) deaths. RDW was analysed as a categorical variable with empirically determined cut points of 13.3 and 15.7 (low RDW <13.3, medium RDW > or = 13.3 to <15.7, high RDW > or = 15.7) based on differences in hazard ratio (HR) for death among RDW deciles. In univariate analysis, higher RDW was a significant predictor of mortality (p < 0.001). In multivariate analysis there was a significant two-way interaction between RDW and haemoglobin (Hgb). RDW was not an independent predictor of mortality in patients with Hgb <10.4. However, among patients with Hgb >10.4, high RDW was a strong and independent predictor of mortality. For patients with Hgb > or = 10.4 to <12.7, HR for death in patients with high RDW relative to low RDW was 5.2 (95% confidence intervals [CI]: 2.0-13.3). For patients with Hgb > or = 12.7, HR for death in patients with high RDW relative to low RDW was 8.6 (CI:2.8-28.6). Higher RDW was a strong and independent predictor of long-term mortality in patients undergoing PCI who were not anaemic at baseline.