Red cell distribution width (RDW) as a predictor of long-term mortality in patients undergoing percutaneous coronary intervention

Summary

Red cell distribution width (RDW) has been shown to be an independent predictor of mortality in patients with coronary artery disease and in patients with heart failure. The current study evaluated the prognostic utility of RDW in patients undergoing percutaneous coronary intervention (PCI). We evaluated 859 patients who underwent PCI during January 2003 to August 2005. After a median follow up of four (interquartile range 3.1 to 4.4) years, there were a total of 95 (11%) deaths. RDW was analysed as a categorical variable with empirically determined cut points of 13.3 and 15.7 (low RDW <13.3, medium RDW ≥13.3 to <15.7, high RDW ≥15.7) based on differences in hazard ratio (HR) for death among RDW deciles.In univariate analysis, higher RDW was a significant predictor of mortality (p<0.001). In multivariate analysis there was a significant two-way interaction between RDW and haemoglobin (Hgb). RDW was not an independent predictor of mortality in patients with Hgb <10.4. However, among patients with Hgb >10.4, high RDW was a strong and independent predictor of mortality. For patients with Hgb ≥10.4 to <12.7, HR for death in patients with high RDW relative to low RDW was 5.2 (95% confidence intervals [CI]: 2.0–13.3). For patients with Hgb ≥12.7, HR for death in patients with high RDW relative to low RDW was 8.6 (CI:2.8–28.6). Higher RDW was a strong and independent predictor of long-term mortality in patients undergoing PCI who were not anaemic at baseline.

Keywords

Red cell distribution width (RDW) - percutaneous coronary intervention - mortality

• References

• 1 Roberts GT, El Badawi SB. Red blood cell distribution width index in some hematologic diseases. Am J Clin Pathol 1985; 08: 222-226.
• 2 Evans TC, Jehle D. The red blood cell distribution width. J Emerg Med 1991; 09 (Suppl. 01) 71-74.
• 3 Looker AC, Gunter EW, Johnson CL. Methods to assess iron status in various NHANES surveys. Nutr Rev 1995; 53: 246-254.
• 4 Van hove L, Schisano T, Brace L. Anemia diagnosis, classification, and monitoring using Cell-Dyn Technology reviewed for the new millennium. Lab Hematol 2000; 06: 93-108.
• 5 Tefferi A, Hanson CA, Inwards DJ. How to interpret and pursue an abnormal complete blood cell count in adults. Mayo Clin Proc 2005; 80: 923-936.
• 6 Felker GM, Allen LA, Pocock SJ. et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol 2007; 50: 40-47.
• 7 Tonelli M, Sacks F, Arnold M. et al. Relation Between Red Blood Cell Distribution Width and Cardiovascular Event Rate in People With Coronary Disease. Circulation 2008; 117: 163-168.
• 8 Cavusoglu E, Chopra V, Gupta A. et al. Relation between red blood cell distribution width (RDW) and allcause mortality at two years in an unselected population referred for coronary angiography. Int J Cardiol. 2009 Epub ahead of print.
• 9 Perlstein TS, Weuve J, Pfeffer MA. et al. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 2009; 169: 588-594.
• 10 Lippi G, Filippozzi L, Montagnana M. et al. Short Communication: Clinical usefulness of measuring red blood cell distribution width on admission in patients with acute coronary syndromes. Clin Chem Lab Med. 2009 Epub ahead of print.
• 11 Marmur JD, Poludasu S, Agarwal A. et al. Highdose tirofiban administered as bolus-only during percutaneous coronary intervention. J Invasive Cardiol 2008; 20: 53-58.
• 12 Marmur JD, Poludasu S, Agarwal A. et al. Bolusonly platelet glycoprotein IIb-IIIa inhibition during percutaneous coronary intervention. J Invasive Cardiol 2006; 18: 521-526.
• 13 Alpert JS, Thygesen K, Antman E. et al. Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000; 36: 959-969.
• 14 Curb JD, Ford CE, Pressel S. et al. Ascertainment of vital status through the National Death Index and the Social Security Administration. Am J Epidemiol 1985; 121: 754-766.
• 15 Braunwald E, Antman EM, Beasley JW. et al. ACC/ AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction--2002: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Circulation 2002; 106: 1893-1900.
• 16 Lin DY, Wei LJ, Ying Z. Checking the Cox model with cumulative sums of Martingale-based residuals. Biometrika 1993; 80: 557-572.
• 17 Lippi G, Targher G, Montagnana M. et al. Relationship between red blood cell distribution width and kidney function tests in a large cohort of unselected outpatients. Scand J Clin Lab Invest 2008; 68: 745-748.
• 18 Rewinecke H, Trey T, Wellmann J. et al. Haemoglobin-related mortality in patients undergoing percutaneous coronary interventions. Eur Heart J 2003; 24: 2142-2150.
• 19 McKechnie RS, Smith D, Montoye C. et al. Prognostic implication of anemia on in-hospital outcomes after percutaneous coronary intervention. Circulation 2004; 110: 271-277.
• 20 Nikolsky E, Aymong ED, Halkin A. et al. Impact of anemia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: analysis from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial. J Am Coll Cardiol 2004; 44: 547-553.
• 21 Levey AS, Coresh J, Balk E. et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003; 139: 137-147.
• 22 Gottlieb SS. Dead is dead--artificial definitions are no substitute. Lancet 1997; 349: 662-663.
• 23 Lauer MS, Blackstone EH, Young JB. et al. Cause of death in clinical research: time for a reassessment?. J Am Coll Cardiol 1999; 34: 618-620.