Red Blood Cell Distribution Width as a 5-Year Prognostic Marker in Patients Submitted to Carotid Endarterectomy
Luís Duarte-Gamas1,2, António Pereira-Neves1,2,3, Filipa Jácome1,2
1Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal.
Insights
Increased red blood cell distribution width-coefficient of variation (RDW-CV) predicts long-term mortality and major adverse cardiovascular events (MACE) after carotid artery endarterectomy (CEA). This low-cost marker aids in identifying patients who may benefit most from CEA.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Surgical Outcomes
Background:
- Carotid artery endarterectomy (CEA) patients face a 6-9% risk of major adverse cardiovascular events (MACE) within 2 years.
- Hematological parameters, like red blood cell distribution width-coefficient of variation (RDW-CV), are linked to adverse outcomes in atherosclerotic diseases, including myocardial infarction (MI), stroke, and mortality.
Purpose of the Study:
- To investigate the predictive role of preoperative hematologic parameters, specifically RDW-CV, for perioperative and long-term cardiovascular events and mortality in CEA patients.
Main Methods:
- A prospective cohort of 180 patients undergoing CEA with regional anesthesia was analyzed.
- Preoperative blood samples were collected for full blood count analysis.
- Outcomes included long-term MACE, all-cause mortality, stroke, MI, acute heart failure, and major adverse limb events (MALE).
Main Results:
- Elevated RDW-CV was observed in 27.2% of patients and independently associated with baseline hemoglobin and atrial fibrillation.
- Increased RDW-CV significantly correlated with long-term all-cause mortality (log-rank <0.001), MACE (log-rank <0.001), and MI (log-rank =0.017).
- Multivariate analysis revealed RDW-CV independently predicted increased long-term mortality (aHR 2.455) and MACE (aHR 2.047).
Conclusions:
- Red blood cell distribution width (RDW) is an accessible, inexpensive biomarker that independently predicts long-term mortality, MACE, and MI post-CEA.
- RDW may assist in identifying CEA patients likely to experience long-term benefits from the procedure.
Objective:
Patients submitted to carotid artery endarterectomy (CEA) have a long-term risk of major adverse cardiovascular events (MACE) of 6-9% at 2 years. Hematological parameters have been shown to have a predictive function in atherosclerotic diseases, namely the red blood cell distribution width-coefficient of variation (RDW-CV). This parameter has been associated with worse outcomes such as myocardial infarction (MI), stroke, and all-cause mortality. This study aims to evaluate the potential role of preoperative hematologic parameters such as RDW-CV in predicting perioperative and long-term cardiovascular adverse events and mortality in patients submitted to CEA.
Methods:
From January 2012 to January 2019, 180 patients who underwent CEA with regional anesthesia in a tertiary care and referral center were selected from a prospective cohort database. Blood samples were collected preoperatively 2 weeks before admission, including a full blood count. The primary outcome included long-term MACE. Secondary outcomes included all-cause mortality, stroke, MI, acute heart failure, and major adverse limb events (MALE).
Results:
At baseline, 27.2% of patients had increased RDW-CV. Increased RDW-CV was independently associated with baseline hemoglobin (adjusted odds ratio [aOR] 0.715, 95% CI 0.588-0.869, p = 0.001) and atrial fibrillation (aOR 4.028, 95% CI 1.037-15.639, p = 0.001). After a median follow-up of 50 months, log-rank univariate analysis of RDW-CV demonstrated a significant association between increased RDW-CV and long-term all-cause mortality (log-rank <0.001), MACE (log-rank <0.001), and MI (log-rank = 0.017). After multivariate Cox regression analysis, increased RDW-CV was associated with increased long-term mortality (adjusted hazard ratio [aHR] 2.455, 95% CI 1.231-4.894, p = 0.011) and MACE (aHR 2.047, 95% CI 1.202-3.487, p = 0.008). A decreased hemoglobin to platelet ratio (aHR 2.650e-8, 95% CI 9.049e-15 to 0.078, p = 0.019) was also associated with all-cause mortality.
Conclusion:
RDW is a widely available and low-cost marker that independently predicts long-term mortality, MACE, and MI after CEA. This biomarker could prove useful in assessing which patients would likely benefit from CEA in the long term.
