The Relation Of RDW With The Severity Of Coronary Artery Disease And Long-term Prognosis In ACS

Background and Objective：Red Blood Cell Distribution Width (RDW) is an indicator which can react thedegree of dispersion of the outer peripheral red blood cell volume. There are two basicforms of it, which included of coefficient of variation of red blood cell distributionwidth (RDW-CV) and red blood cell distribution width standard deviation (RDW-SD).RDW-CV in the crowd shows a normal distribution, it is widely used in clinicalpractices for the diagnosis of different kinds of anemia. In recent years, studies haveshown that baseline level of RDW is closely related with a variety of heart diseases,such as heart failure, coronary heart disease, hypertension, pulmonary hypertension,peripheral vascular disease, coronary artery dilatation anomaly. This study aimed toexplore the changes of RDW in Acute Coronary Syndrome (ACS), to analyze relation ofRDW with the severity of coronary artery disease and long-term (2-year) prognosis.Methods:A total of218patients(aged27-85years,54.59%men) were enrolled in this study,including140patients with ACS and78patients without ACS. The group of ACScontained60patients with STEMI and26patients with NSTEMI and54patients withUA. All of them had CAG and then Gensini score was calculated. The relation of RDWand Gensini score and the cumulative count of coronary lesions were analysised. Alldetailed records of general condition and results of the routine examinations wererecorded. Every ACS patient had an interview by phone after two years to evaluateadverse cardiovascular events during the two years, such as angina pectorals grade of CCS raised at least of1grade, onset of heart failure, recurrence of myocardial infarction,cardiac death. According to the thresholds of RDW determined by ROC curve analysis,ACS patients were divided into high-levels group and low-levels group, the incidence oflong-term adverse cardiovascular events between the two groups was compared.Results:1. Compared with control group patients, the clininal baseline of ACS group washigher on indicators of the proportion of men, diabetes prevalence, hypertensionprevalence, the proportion of smoking, the proportion of drinking, LAD and LVED,while lower on indicator of LEVF. Comparing blood biochemical testing results, theresults showed that ACS group patients had higher level on the indicators of WBC, PLT,AST, LDH, TC, LDL-C, apolipoprotein B, fasting plasma glucose, urea nitrogen, serumcreatinine, hsCRP, cTnI, NT-proBNP and RDW than control group patients, while thelower level on PLT, HDL-C, apolipoprotein A1. The average level of RDW wassignificantly higher in ACS group than it in control group[(12.81±0.55)%vs (12.28±0.41)%, P <0.001]. ACS patients with myocardial infarction had higher level of RDWthan those without myocardial infarction.2. Spearman correlation analysis showed that RDW was positively associated withGensini score significantly(r=0.463, P<0.001), and also positive linear correlated withcoronary artery lesions(r=0.295, P <0.001).3. ROC curve analysis showed that test performance was the best when RDW was12.85%[area under curve=0.87, p<0.001]. Compared with the low-levels group(RDW<12.85%), high-levels group (RDW≥12.85%) had the following characteristics:1)WBC,AST, LDH, hs-CRP, cTNI were significantly higher;2) cardiac ultrasound showed thatthe dates of LAD and LVED were higher and LEVF was lower;3) more multivessel andleft-main vessel disease patients;4) the Gensini score was higher. There were57casesof adverse cardiovascular events during the two-year follow-up periods. Compared withlow-levels group, the incidence of long-term cardiovascular events of high-levels groupincreased significantly(56.72%vs26.03%, P<0.001). Logistic regression analysis showed that NT-proBNP(P=0.007), LDL-C(P=0.038), apolipoprotein-B(P=0.030) andRDW(P=0.010) were the predictors of long-term adverse cardiovascular events.4.Spearman correlation analysis also showed that RDW was positively correlatedwith WBC, AST, LDH, cTnI, hs-CRP, NT-proBNP and LVED, while it was negativelyrelative with LVEF and MCV. Multiple stepwise regression analysis showed that RDWwas positively correlated with WBC (r=0.232, P<0.001) and hs-CRP (r=0.352, P<0.001),while negatively correlated with LVEF (r=-0.213, P<0.001).Conclusion:1.The level of RDW in patients with ACS increased significantly, and ACS patientswithAMI had higher level of RDW compared with those withoutAMI.2. RDW was closely related with Gensini score. Patients with more severecoronary artery disease had higher level of RDW.3. RDW was relevant to the incidence of long-term cardiovascular events in ACSpatients. The higher level of RDW might indicate poor outcome. RDW might be one ofthe predictors for long-term cardiovascular events in patients withACS.4.RDW was significantly correlated with WBC, hs-CRP, NT-proBNP and LVEF.High-levels of RDW in ACS patients might be correlated with inflammatory reactionand downgrade of cardiac function level.