0243: Complete blood count in risk stratification of acute coronary syndromes: a routine blood test, many analytical parameters, which is the best?

Abstract

Risk stratification is a key element to treatment optimization and prognostic assessment in acute coronary syndromes (ACS). The aim of the present study was to evaluate and compare the predictive power (PP) of 6 month mortality (6M) of different complete blood count parameters in patients (P) with ACS. Retrospective study including P with ACS consecutively admitted to a coronary care unit over 4 years and a minimal 6 month follow-up. In all P the following CBC parameters were evaluated in the first 24 hours: hemoglobin (Hg), hematocrit (Htc), red blood cell distribution width (RDW) and platelets (Pl). In a subgroup of 540 P admitted over a 1 year, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), leukocytes (L) and neutrophils (N) were also evaluated. We included 1906 P (mean age 64±13y; 49,9% with ST-elevation infarction). The in-hospital mortality was 3,9% and 6M was 8,9%. After calculation of 6M AUC, only Hg (0,712; p<0,001), Htc (0,703; p<0,001) and RDW (0,622; p=0,05) had PP of 6M. There were no statistically significant differences between the PP of Hg, Hct and RDW. From the cut-off values obtained, a multivariate logistic regression model was constructed. Only Hct and RDW persisted as independent predictors of 6M, with an OR of 3,6 (CI 95%; 2,18-40,43; p<0,001) and 2,8 (CI 95%; 1,04-7,67; p=0,04), respectively. In a subgroup of P, in addition to previous parameters, L (0,598; p=0,04) and N (0,619; p=0,014) also had PP of 6M. There were no statistically significant differences between the PP of Hg, Hct, RDW, L and N, with the exception of RDW that had a stronger PP than L (p=0.032). After multivariate analysis, L and N also persisted as independent predictors of 6M, with an OR of 5,1 (CI 95%; 1,42-18,18; p=0,012) and 3,0 (CI 95%; 1,04-8,74; p=0,04), respectively. CBC is a routine blood test, which includes parameters that without extra costs can be helpful in risk stratification of ACS. In the present study, Hg, Hct, RDW, L and N had PP for 6M in ACS. There were no significant differences regarding the PP of 6M between these variables, with the exception of RWD that had a stronger PP than L.