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Association between red blood cell distribution width and outcomes at six months in patients with acute coronary
Sérgio Nabais1, Nuno Losa, António Gaspar
1Serviço de Cardiologia, Hospital de S. Marcos, Braga, Portugal. sergionnabais@gmail.com
Insights
Higher red blood cell distribution width (RDW) is linked to worse outcomes in acute coronary syndrome (ACS) patients. This easily measured marker predicts adverse cardiovascular events and mortality within six months post-ACS.
Area of Science:
- Cardiology
- Hematology
- Clinical Medicine
Background:
- Red blood cell distribution width (RDW) elevation is associated with adverse outcomes in heart failure and stable coronary artery disease.
- The relationship between RDW and outcomes in acute coronary syndromes (ACS) requires further investigation.
Purpose of the Study:
- To assess the hypothesis that higher RDW values are associated with adverse cardiovascular outcomes in patients with ACS.
- To determine if RDW is an independent predictor of adverse events in ACS.
Main Methods:
- A cohort of 1796 patients admitted with ACS to a coronary care unit was studied.
- Clinical and laboratory data, management, and outcomes were analyzed based on baseline RDW tertiles.
- The primary outcome was a composite of death or myocardial infarction (MI) at six-month follow-up.
Main Results:
- Patients with higher RDW tertiles were older, more likely female, had a history of MI, and presented with renal dysfunction, anemia, and higher Killip class.
- A significant trend of increased 6-month mortality and death/MI rates was observed with increasing RDW tertiles (p = 0.001 and p < 0.0001, respectively).
- Adjusted analysis revealed RDW as an independent predictor of the composite outcome (OR 1.43 for highest vs. lowest tertile; p = 0.049), with a 1.16 OR per 1% RDW increase (p = 0.017).
Conclusions:
- RDW is an easily accessible and valuable predictor of outcomes in patients with ACS.
- A graded, independent association exists between elevated RDW values and adverse cardiovascular outcomes following ACS.
Background:
Higher values of red ceildistribution width (RDW) may be associated with adverse outcomes in patients with heart failure and in those with stable coronary artery disease. We assessed the hypothesis that higher RDW values are associated with adverse cardiovascular outcomes in patients with acute coronary syndromes (ACS).
Methods:
We studied 1796 patients with ACS admitted to a coronary care unit. We analyzed clinical and laboratory characteristics, management, and outcomes of patients according to tertiles of baseline RDW. The primary outcome was death or myocardial infarction (MI) during six-month follow-up.
Results:
Patients with higher RDW values tended to be older, were more likely to be female and have a history of MI, and more often had renal dysfunction, anemia, and Killip class >I on admission (p < 0.05). Higher RDW values were associated with increased 6-month mortality (tertile 1: 8.2%; tertile 2: 10.9%; tertile 3: 15.5%; p = 0.001 for trend) and increased 6-month death/MI rates (tertile 1, 13.0%; tertile 2, 17.2%; tertile 3, 22.9%; p < 0.0001 for trend). An association between higher RDW and increased 6-month death/MI rates was found in patients with non-ST-elevation ACS (10.5% vs. 15.3% vs. 22.7%; p < 0.001 for trend), with a tendency in patients admitted with ST-elevation MI (15.1% vs. 19.1% vs. 23.1%; p = 0.053 for trend). After adjustment for baseline characteristics and treatment, higher RDW values remained independently associated with the study's primary composite outcome but not with all-cause death. Using the first tertile of RDW as reference, the adjusted odds ratio (OR) for 6-month death/MI among patients in the highest RDW tertile was 1.43 (95% confidence interval [CI], 1.00-2.05; p = 0.049). Using RDW as a continuous variable, the adjusted OR for 6-month death/MI was 1.16 (95% CI, 1.03-1.30; p = 0.017) per 1% increase in RDW.
Conclusions:
RDW is an easily determined predictor of outcome after ACS. We found a graded independent association between higher RDW values and adverse outcomes in patients with ACS.
