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Published on: September 15, 2023
Can red blood cell distribution width predict long-term cardiovascular event after off-pump coronary artery bypass? A
Hengchao Wu1, Xianqiang Wang1, Jing Zhang1
1State Key Laboratory of Cardiovascular Disease, Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China.
Insights
Higher red blood cell distribution width (RDW) levels in patients undergoing off-pump coronary artery bypass (OPCAB) surgery are linked to increased long-term cardiac events. An RDW above 13% indicates a higher risk for major adverse cardiac and cardiovascular events (MACCE).
Area of Science:
- Cardiology
- Biomarkers in Cardiovascular Disease
- Surgical Outcomes
Background:
- The prognostic value of red blood cell distribution width (RDW) for long-term outcomes after off-pump coronary artery bypass (OPCAB) remains under-investigated.
- Understanding RDW's impact is crucial for risk stratification in patients undergoing coronary artery bypass grafting.
Purpose of the Study:
- To investigate the association between RDW and the risk of major adverse cardiac and cardiovascular events (MACCE) in patients who underwent OPCAB.
- To determine if RDW is an independent predictor of long-term MACCE after OPCAB.
Main Methods:
- Retrospective analysis of 440 nonanemic patients undergoing OPCAB.
- Long-term follow-up (median 7.0 years) to ascertain MACCE (death, myocardial infarction, repeat revascularization, stroke).
- Cox proportional hazards models and receiver-operating characteristic (ROC) analysis to evaluate RDW's predictive value.
Main Results:
- Patients with MACCE had significantly higher admission RDW levels (13.1 ± 0.7%) compared to those without (12.8 ± 0.7%).
- Each 1% increase in RDW was associated with a significantly increased risk of MACCE (HR 1.520-1.795).
- An RDW cut-off of 13% predicted MACCE, with patients RDW ≥13% having a 1.829-fold increased risk (P=0.019).
Conclusions:
- Admission RDW level greater than 13% is an independent predictor of increased long-term MACCE risk following OPCAB.
- RDW serves as a valuable, easily accessible biomarker for risk stratification in OPCAB patients.
- Higher RDW levels are associated with poorer long-term cardiovascular outcomes after OPCAB.
Introduction:
The effect of red blood cell distribution width (RDW) on long-term major cardiac and cardiovascular event (MACCE) in patients with off-pump coronary artery bypass (OPCAB) has not been adequately studied. We investigated the relationship between RDW and the risk of MACCE in patients who underwent OPCAB.
Methods:
We retrospectively analyzed the data of 440 consecutive, nonanemic patients (362 males; 82.27% and mean age 60.8 ± 8.9 years) who underwent OPCAB between October 2009 and September 2012 in Fuwai Hospital. Long-term follow-up was obtained through phone calls, hospital records, and clinic visits. MACCE (death, ST elevated infarction, repeat coronary revascularization, stroke) was determined.
Results:
Over a median of 7.0-year follow-up, 80 incident MACCE events were identified. The RDW levels on admission were significantly higher in MACCE group than non-MACCE group (13.1 ± 0.7 vs 12.8 ± 0.7; P = .005). Using the Cox proportional hazards models, we found that per 1% increment of RDW, the incident of MACCE was increased in different models (hazard ratio [HR] was 1.520, 1.532, and 1.795, respectively; P = .002, .004, and .002). The receiver-operating characteristic analysis revealed an RDW cut-off value of 13% predicting MACCE. Therefore, patients were grouped on this cut-off value. The Kaplan-Meier plot revealed significantly lower event-free survival in the higher RDW group (P = .0158). Compared with subjects in the RDW <13% in full model, subjects in the RDW ≥13% had an HR of 1.829 (95% confidence interval, 1.103-3.032; P = .019).
Conclusions:
An RDW level greater than 13% in hospital admission is independently associated with an increased incidence of long-term MACCE after OPCAB.
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