Author + information
- Ramazan Can Öncel1,
- Mustafa Uçar1,
- Mustafa Serkan Karakaş2,
- Barış Akdemir3,
- Atakan Yanıkoğlu1,
- Ali Rıza Gülcan4,
- Refik Emre Altekin1 and
- İbrahim Demir1
Red cell distribution width (RDW), a measure of the variability in size of circulating erytrocytes, has been reported to be a risk marker of morbidity and mortality for cardiovascular disease. In this study, we aimed to investigate the association of the NLR with Global Registry of Acute Coronary Events (GRACE) risk score and in-hospital major advanced cardiac events in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).
We analyazed 101 consecutive STEMI patents treated with primary PCI. Patients were divided into 3 groups by use of GRACE risk score. The RDW was calculated as a part of automated complete blood count. The association between RDW and GRACE risk score was assessed.
The study population consisted of 101 consecutive STEMI patients. 80.2% of patients were male and mean age of patients was 57.97±12.24 years. 42 patients were hypertensive,23 patients were diabetic,34 patients were hyperlipidemic and 57 were smoker. According to the GRACE risk score,21 patients had low GRACE risk scores,48 patients had intermediate GRACE risk scores, 32 patients had high GRACE risk scores. Demographic and biochemical characteristics of patients in GRACE risk score groups are shown in table 1. The RDW values were significantly higher in patients with intermediate and high GRACE risk scores than in the low GRACE risk scores. There were no significant differences between low and intermediate GRACE risk scores in respect to RDW. (Table 1, Figure 1).
Correlation with In-Hospital Events During the in-hospital period, 11 patients (10.9%) presented cardiac events (3 cardiac death, 2 reinfarction, 6 new-onset heart failure). These patients had more advanced Killip functional class and higher GRACE risk score. The occurrence of in hospital cardiac death, reinfarction or new-onset heart failure was significantly related to RDW at admission (15.11±1.56 vs. 13.64±1.18, p=0.002). Likewise RDW and GRACE risk score showed a significant positive correlation. (r=0.376, p<0.001) (Figure 2). The cut off level of RDW which best predicts an unfavorable in hospital cardiac events was 14.3 with a sensivity of 72.7%; specifity of 76% (Figure 3).
RDW is a newly recognized and widely available diagnostic marker, routinely performed hemogram. Unlike many other inflammatory markers and bioassays, RDW is an inexpensive and readily available marker that provides an additional level of risk scores in predicting inhospital and long-term outcomes. Although the GRACE risk score is routinely used for stratification of patients with acute coronary syndrome, RDW may provide additional prognostic value. Increased RDW is independently associated with a higher rate of in-hospital cardiac events. The determination of RDW for risk stratification of STEMI patients during hospitalization may be useful.
|Men, n (%)||16 (76.2%)||43 (89.6%)||22 (68.8%)||0.063|
|HT, n (%)||9 (42.9%)||13 (21.7%)||20 (62.5%)||0.007|
|DM, n (%)||3 (14.3%)||11 (22.9%)||9 (28.1%)||0.501|
|HPL, n (%)||11 (52.4%)||13(27.1%)||10 (31.3%)||0.116|
|Smoker, n (%)||15 (71.4%)||28 (58.3%)||14 (43.8%)||0.130|
Demographic and biochemical characteristics of patients in GRACE risk score groups (Abbreviations: BMI, body mass index; HT, hypertension; DM, diabetes mellitus; HPL, hyperlipidemia; WBC, white blood cell; RDW, red cell distribution width † p<0.001 compared with GRACE 108-140 points, ‡ p<0.001 compared with GRACE>140 points, * p<0.001 compared with GRACE<108 points, ** p=0.007 compared with GRACE<108 points, †† p=0.01 compared with GRACE<108 points, ‡‡p=0.407 compared with GRACE<108 points)