Abstract
The values of hematological and coagulation biomarkers were evaluated as predictors of in hospital mortality and complications, in patients with acute coronary syndromes (ACS). This retrospective observational study enrolled 936 ACS subjects admitted to the Clinical Emergency Hospital of Oradea, Romania, between January–December 2019. Hematological and coagulation parameters were obtained at admission. During hospitalization, the following adverse events were recorded: death, ventricular rhythm disturbances, atrial fibrillation, heart failure, re-infarction, and stroke. Accuracy of hematological and coagulation parameters as predictors of adverse outcome were also evaluated. The diagnosis was unstable angina in 442 patients (47.22%), non-ST-elevation myocardial infarction (NSTEMI) in 113 patients (12.1%) and ST-elevation myocardial infarction (STEMI) in 381 patients (40.70%); 87 patients (9.29%) died during hospitalization and 193 (20.7%) developed complications. Predictors for in hospital mortality were as follows: red cell distribution width (RDW) (AUC 0.691, p < 0.0001), white blood cells (WBC) (AUC 0.684, p < 0.0001), neutrophils (NEU) (AUC 0.684, p < 0.0001), and prothrombin time (PT) (AUC 0.765, p < 0.0001). WBC (AUC 0.659, p < 0.0001), NEU (AUC 0.664, p < 0.0001), RDW (AUC 0.669, p < 0.0001), and PT (AUC 0.669, 95% CI 0.622–0.714, p < 0.0001) also had accuracy for complications prediction. RDW had a good ability to predict heart failure in NSTEMI patients (AUC 0.832, p < 0.0001). An acceptable ability to predict ventricular rhythm disturbances occurrence had WBC (AUC 0.758, p < 0.0001) and NEU (AUC 0.772, p < 0.0001). Hematological and coagulation parameters can help in risk stratification of ACS patients. RDW, WBC, NEU, and PT were able to predict mortality and in-hospital complications in ACS patients. RDW has a good accuracy in predicting complications and heart failure in NSTEMI patients. WBC and NEU are good predictors for ventricular rhythm disturbances.
Highlights
Coronary artery disease (CAD) is the leading cause of death worldwide and is most commonly the result of atherosclerosis
An acceptable ability to predict ventricular rhythm disturbances occurrence in acute coronary syndromes (ACS) patients had white blood cells (WBC) (AUC 0.758, 95% CI 0.726–0.788, p < 0.001) and NEU (AUC 0.772, 95% CI 0.741–0.802, p < 0.001)
An increased admission red cell distribution width (RDW) is correlated with in-hospital and long-term mortality in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) in a retrospective study performed by Uyarel et al [14] and RDW is a predictor of mortality and of adverse clinical outcome in patients with acute MI in a prospective study performed by Dabbah et al [7]
Summary
Coronary artery disease (CAD) is the leading cause of death worldwide and is most commonly the result of atherosclerosis. Atherosclerosis is a systemic inflammatory disease, and inflammation plays an important role in the pathophysiology of acute coronary syndromes (ACS). There is a persistent low-grade inflammation that contributes to the initiation and progression of the atherosclerotic process. Atherosclerosis plaques may become unstable leading to thrombosis and development of ACS. Acute coronary syndrome (ACS), including unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI), is one of the most frequent reasons for hospital admission [1]. Despite the use of guideline recommended therapies including early percutaneous coronary intervention (PCI) the prognosis in ACS is still poor and early risk stratification is needed [2,3]
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