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Red blood cell distribution width predicts long term cardiovascular event after on-pump beating coronary artery
Orcun Gurbuz1, Gencehan Kumtepe2, Hakan Ozkan3
1Department of Cardiovascular Surgery, Balikesir University, School of Medicine, 10010, Balikesir, Turkey. gurbuzorcun@gmail.com.
Insights
Higher red cell distribution width (RDW) independently predicts major adverse cardiac and cardiovascular events (MACCE) after coronary artery bypass grafting (CABG). This finding suggests RDW is a crucial prognostic marker for CABG patients.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Hematology
Background:
- Previous studies on red cell distribution width (RDW) and major adverse cardiac and cardiovascular events (MACCE) after coronary artery bypass grafting (CABG) were limited by confounding factors like anemia.
- The need exists to determine the independent predictive value of RDW for MACCE following CABG.
Purpose of the Study:
- To ascertain the independent effect of elevated RDW levels on MACCE in patients undergoing CABG, excluding anemia as a confounding factor.
Main Methods:
- Retrospective analysis of 500 non-anemic patients who underwent on-pump off-pump coronary artery bypass grafting (ONBHCAB) between January 2007 and January 2010.
- Multivariate Cox regression and Receiver Operating Characteristic (ROC) curve analysis were employed to identify predictors of MACCE.
- Patients were categorized into lower and higher RDW groups based on a determined cut-off value.
Main Results:
- Red cell distribution width (RDW) was identified as the sole independent predictor of MACCE (P = 0.022) in multivariate analysis.
- An RDW cut-off value of 13.95% was established for predicting MACCE.
- Patients with higher RDW (Group 2) exhibited significantly lower event-free survival (P < 0.001) and a higher incidence of MACCE at 1, 3, and 6 years post-CABG compared to the lower RDW group (Group 1).
Conclusions:
- An RDW level exceeding 13.95% upon hospital admission is an independent risk factor for increased MACCE after CABG.
- These findings underscore the importance of considering RDW in risk stratification for CABG patients.
- Physicians should adopt a more aggressive management strategy for non-anemic patients with elevated RDW undergoing CABG.
Background:
Reports investigating the predictive value of red cell distribution width (RDW) on major cardiac and cardiovascular event (MACCE) following coronary artery bypass grafting (CABG) have major limitations, including lack of elimination of common factors affecting RDW levels, such as anemia. The purpose of this study is to identify the real effect of higher RDW level, free from the other factors, on MACCE following CABG.
Methods:
Data of 500 consecutive, non-anemic patients (77.2 % male and mean age 63.05 ± 9.24) undergoing ONBHCAB between January 2007 and January 2010, were analyzed retrospectively.
Results:
Overall MACCE was 7.8 % of all cases. Mean follow-up was 66.5 ± 9.96 months. In multivariate Cox regression analysis, RDW (P = 0.022) remained the only independent predictor of MACCE and the ROC analyze revealed an RDW cut-off value of 13.95 % predicting MACCE. Therefore, patients were grouped on this cut-off value. There were 238 patients in the lower RDW group (Group 1) and 262 patients in the higher RDW group (Group 2). Kaplan-Meier survival analysis of freedom from MACCE revealed significantly lower event free survival in Group 2 (P < 0.001 by the log-rank test). Group 2 showed a higher MACCE incidence in 1 year (P = 0.030), in 3 years (P < 0.001) and in 6 years (P < 0.001). The long-term follow-up was similar regarding noncardiovascular mortality.
Conclusion:
An RDW level greater than 13.95 % in hospital admission is independently associated with an increased incidence of MACCE after CABG. Physicians should be more aggressive in the management of these patients.
