Abstract
The combined value of RDW and GRACE risk score for cardiovascular prognosis in ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not been fully investigated. This study was designed to explore the combined value of RDW and GRACE risk score on predicting long-term major adverse cardiac event (Mace) in STEMI patients undergoing primary PCI. This study included 390 STEMI patients. The primary endpoint at the (33.5 ± 7.1) months follow-up was composed of cardiac death and nonfatal myocardial infarction. The relationship between clinical parameters and clinical outcomes was evaluated using Cox regression model and receiver operating characteristic (ROC) analysis. Mace occurred in 126 (32.3%) patients including 54 (13.8%) cardiac deaths and 72 (18.5%) nonfatal myocardial infarctions. Patients in Mace group had significantly higher RDW and GRACE score than the patients in non-Mace group. According to the Cox model, RDW and GRACE score were the most important independent predictors of Mace and cardiac death. The best cut-off value for RDW to predict the occurrence of primary events was 13.25% (AUC = 0.694, 95% CI:0.639–0.750, P < 0.001) and that for GRACE score was 119.5 (AUC = 0.721, 95% CI:0.666–0.777, P < 0.001). The combination of RDW and GRACE score were more valuable (AUC = 0.775, 95% CI: 0.727–0.824, P < 0.001). Kaplan–Meier analysis provided significant prognostic information with the highest risk for cardiac death (Log-Rank χ2 = 24.684, P < 0.001) in group with both high RDW (> 13.25%) and high GRACE score (> 119.5). The combination of RDW level and GRACE score may be valuable and simple independent predictors of Mace and cardiac death in STEMI patients undergoing primary PCI. They may be useful tools for risk stratification and may indicate long-term clinical outcomes.
Highlights
Red blood cell distribution width (RDW) is a parameter of circulating erythrocytes measured by hematology analyzer
The best cut-off value for RDW to predict the occurrence of primary events was 13.25% (AUC = 0.694, 95% confidence interval (CI):0.639–0.750, P < 0.001) and that for Global Registry of Acute Coronary Events (GRACE) score was 119.5 (AUC = 0.721, 95% CI:0.666–0.777, P < 0.001)
No significant association has been found between either RDW (r = 0.063, P = 0.216) or hypersensitive C reactive protein (hsCRP) (r = 0.007, P = 0.895) and GRACE score
Summary
Red blood cell distribution width (RDW) is a parameter of circulating erythrocytes measured by hematology analyzer. It is calculated automatically or manually by formula and expressed as a percentage. Increased attention has been focused on the predictive and prognostic value of RDW in patients with coronary heart disease, heart failure, atrial fibrillation, aortic valve replacement surgery, acute pulmonary embolism and cerebral infarction [4,5,6,7,8,9,10]. High RDW is associated with cardiovascular events and mortality in patients after myocardial infarction [12]
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