Predictive impact on mediumterm mortality of hematological parameters in Acute Coronary Syndromes: added value on top of GRACE risk score

Abstract

Background: Red Cell Distribution Width (RDW) prognostic value in patients with Acute Coronary Syndrome (ACS) has been well validated whereas that of Platelet Distribution Width (PDW) is less well known. Objectives: Investigate the incremental prognostic value, on top of GRACE risk score, of a new variable resulting from the combination of RDW and PDW. Methods: Consecutive patients with ACS. Complete blood count, with RDW and PDW, was obtained. Primary endpoint was one-year all-cause mortality and Cox regression models were used to measure the influence of RDW and PDW on patients' survival time. A new combination categorical variable (RDW/PDW) was created with both discretized RDW and PDW and logistic regression models were used. Predictive value and discriminative ability of the model with GRACE risk score alone and of the model with inclusion of RDW/PDW was assessed. Results: We included 787 patients. Hospital and one-year mortality rates were 5.1% and 7.8%, respectively. Both continuous RDW and PDW were independent predictors of death. The best cut-off for RDW was 13.9%, and 14.5% for PDW. Inclusion of RDW/PDW in a model with GRACE risk score improved the AUC from 0.81 (95% CI 0.75-0.86) to 0.84 (95% CI 0.79-0.90) (p=0.024) with an improvement in total NRI (56%) and IDI (0.048). Conclusions: Simple markers such as RDW and PDW can be useful in risk stratification of death after ACS. Combining both markers with GRACE risk score improved the predictive value for all-cause mortality and reduced the estimated risk of those who did not die.

Relation of platelet indices to severity of coronary artery disease in patients undergoing primary percutaneous coronary intervention

“…It was also reported that adding both RDW and PDW to the GRACE Risk Score can enhance the prediction of all causes of mortality in patients with acute coronary syndrome. 15 Adam et al 16 reported that PDW was associated with the severity of carotid artery stenosis as determined by multidetector row computed tomography angiography. This association suggested that PDW may be a marker of early atherosclerosis.…”

The diagnostic and prognostic value of red cell distribution width in cardiovascular disease; current status and prospective

“…Similarly, it has been reported that a high RDW at the time of hospital admission in patients with stable coronary artery disease (SCAD) is associated with an enhanced mortality and incidence of ACS within the subsequent year . RDW may also be helpful in evaluation of risk of mortality after ACS . Nabais et al studied 1,796 patients with ACS, and showed that increased RDW is an independent risk factor for 6‐month mortality or MI in patients with ACS .…”

“…25 RDW may also be helpful in evaluation of risk of mortality after ACS. 26 Nabais et al studied 1,796 patients with ACS, and showed that increased RDW is an independent risk factor for 6-month mortality or MI in patients with ACS. 27 Poludasu et al studied patients who underwent PCI and showed that an increased RDW was a risk factor for mortality in patients with normal level of hemoglobin at baseline.…”

Impact of red blood cell distribution width on non-cardiac mortality in patients with acute decompensated heart failure with preserved ejection fraction

“…RDW represents a variability of sizes of circulating erythrocytes and is combined with the mean corpuscular volume for the differential diagnosis of microcytosis such as thalassemia, iron deficiency, and chronic disease-related anemia [8,9]. Recently, RDW has been extensively investigated as a significant predictor of clinical outcomes for various disorders, such as acute coronary syndrome, malignancy, and infectious diseases [10][11][12].…”