Elevated red cell distribution width level predicts worse postinterventional thrombolysis in myocardial infarction flow reflecting abnormal reperfusion in acute myocardial infarction treated with a primary coronary intervention

Abstract

Red cell distribution width (RDW), a measure of circulating erythrocyte size heterogeneity, is an established predictor of long-term prognosis and also all-cause mortality in a variety of cardiovascular settings. The correlation of RDW and reperfusion in acute myocardial infarction (AMI) has not been reported. Herein, we aimed to demonstrate the impact of an elevated RDW level on the postinterventional thrombolysis in myocardial infarction (TIMI) flow in AMI patients. A total of 556 patients with an ST elevation AMI were evaluated retrospectively. Upon admission, the RDW level was measured with an automated complete blood count. Postinterventional TIMI flow was documented for all patients. Then, the patients were classified according to the RDW level and the TIMI flow. TIMI 0-1-2 flow was defined as abnormal reperfusion and RDW more than 14.8% was defined as elevated level. All groups were statistically compared according to the preinterventional clinical and demographic features. Abnormal reperfusion was observed in 26% of the patients. Advanced age, female sex, diabetes mellitus, and hypertension were correlated with TIMI flow less than 3. Elevated RDW (>14.8%) was observed in 21.9% of the patients and it was more common in patients who were older, women, and hypertensive patients. Elevated RDW was also strongly correlated with TIMI flow less than 3 (P<0.001). In addition, elevated RDW was found to be an independent predictor of abnormal reperfusion in multivariate regression analysis (odds ratio: 2.20, with a 95% confidence interval 1.012-4.569; P=0.05). An elevated RDW level on admission is associated with worse reperfusion in AMI treated with a primary coronary intervention, which could be one of the factors that may contribute toward the association between elevated RDW and long-term adverse cardiovascular outcomes and mortality.