Combined Value of Red Blood Cell Distribution Width and Global Registry of Acute Coronary Events Risk Score for Predicting Cardiovascular Events in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

Na Zhao,Xiaojun Liu,Yu Xiang,Dongyu Xia,Yong Zhang,Shuo Pan,Gongchang Guan,Zhongwei Liu,Junkui Wang,Zuyi Yuan,Lan Mi,Jiaojiao Xu,Michael J Lipinski

doi:10.1371/journal.pone.0140532

Abstract

Global Registry of Acute Coronary Events (GRACE) risk score and red blood cell distribution width (RDW) content can both independently predict major adverse cardiac events (MACEs) in patients with acute coronary syndrome (ACS). We investigated the combined predictive value of RDW and GRACE risk score for cardiovascular events in patients with ACS undergoing percutaneous coronary intervention (PCI) for the first time. We enrolled 480 ACS patients. During a median follow-up time of 37.2 months, 70 (14.58%) patients experienced MACEs. Patients were divided into tertiles according to the baseline RDW content (11.30–12.90, 13.00–13.50, 13.60–16.40). GRACE score was positively correlated with RDW content. Multivariate Cox analysis showed that both GRACE score and RDW content were independent predictors of MACEs (hazard ratio 1.039; 95% confidence interval [CI] 1.024–1.055; p < 0.001; 1.699; 1.294–2.232; p < 0.001; respectively). Furthermore, Kaplan–Meier analysis demonstrated that the risk of MACEs increased with increasing RDW content (p < 0.001). For GRACE score alone, the area under the receiver operating characteristic (ROC) curve for MACEs was 0.749 (95% CI: 0.707–0.787). The area under the ROC curve for MACEs increased to 0.805 (0.766–0.839, p = 0.034) after adding RDW content. The incremental predictive value of combining RDW content and GRACE risk score was significantly improved, also shown by the net reclassification improvement (NRI = 0.352, p < 0.001) and integrated discrimination improvement (IDI = 0.023, p = 0.002). Combining the predictive value of RDW and GRACE risk score yielded a more accurate predictive value for long-term cardiovascular events in ACS patients who underwent PCI as compared to each measure alone.

Highlights

Accurate risk stratification of patients with acute coronary syndrome (ACS) is important to efficiently target the use of evidence-based therapies and to identify high-risk patients who may benefit from advanced treatments
We investigated the individual value of red blood cell distribution width (RDW) content and Global Registry of Acute Coronary Events (GRACE) score for predicting major adverse cardiac events (MACEs) in patients with ACS undergoing percutaneous coronary intervention (PCI)
The addition of RDW to GRACE score significantly improved the reclassification (0.352, p < 0.001) and the integrated discrimination (0.023, p = 0.002) of subjects compared to GRACE score system (Table 5). These results revealed that the predictive value of adding RDW to the GRACE score was superior to the predictive value of the GRACE score alone in predicting MACEs

Summary

Introduction

Accurate risk stratification of patients with acute coronary syndrome (ACS) is important to efficiently target the use of evidence-based therapies and to identify high-risk patients who may benefit from advanced treatments. The clinical and laboratorial variables used by this risk scoring system include heart rate, systolic blood pressure, serum creatinine, and troponin. This system reflects only certain pathophysiological dimensions related to outcomes in ACS; biomarkers that addressed separate aspects of ACS pathophysiology could provide additional information. Considerably large clinical datasets have found that increased red blood cell distribution width (RDW) was a strong independent predictor of cardiovascular events in patients with heart diseases including ACS [8,9,10,11,12]. We studied the significance of adding the RDW to the GRACE score for use as a combined predictor

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Conclusion