| Background：Recently, several studies have reported a strong independent associationbetween high red blood cell distribution width (RDW) and the risk of adverse outcomes inpatients with heart failure, acute ST-segment elevation myocardial infarction (STEMI),acute Non-ST-segment elevation myocardial infarction (STEMI), acute coronary syndrome(ACS) and in patients under-going primary angioplasty for acute myocardial infarction,even in the general population. Besides, it is closely related to the presence and severity ofcoronary artery disease. However, no study regarding the prognostic effect of RDW inpatients undergoing primary PCI with ACS exists in the literature. The precise mechanismis not clear. Several studies revealed that a chronic inflammatory state and neurohumoralactivation may contribute to adverse clinical outcomes in patients with coronary arterydisease and those with heart failure. Therefore, we hypothesized that inflammatory isassociated with higher RDW and increased mortality in patients undergoing primary PCIwith ACS. To test this hypothesis, we analyzed the association of white blood count withRDW in patients mentioned above.Objective: We examined the correlation between RDW and the risk of adversecardiovascular outcomes in a population of people undergoing primary PCI with ACS, andthe association of white blood count with RDW to test our hypothesis that inflammatorymay be a mechanistic link between higher RDW and increased adverse cardiovascularoutcomes in patients undergoing primary PCI with ACS.Method:1. We studied376consecutive patients admitted to our hospital undergoing primary PCI with ACS from August2009to December2010. Of those patients,311caseswere diagnosed as ST-segment elevation myocardial infarction (STEMI),31cases werediagnosed as non ST-segment elevation myocardial infarction (NSTEMI),34cases werediagnosed as unstable angina (UA). All patients were followed to December2011or untilmajor adverse cardiovascular events occurred. During follow-up, we observed theincidence of major adverse cardiovascular events，recurrent myocardial infarction, pectorisangina, heart failure and cardiac death included.2. All patients were divided into two groups according to the median of RDWmeasured immediately on admission. Then we compared the association of major adversecardiovascular events with RDW between the lower and higher group.3. We compared clinical characteristics between the two groups, and did correlationanalysis between RDW and statistically significant variables. In order to determine if thevariables are independently associated with RDW levels, we carried out stepwisemultivariate linear regression between statistically significant variables that filtered fromcorrelation analysis and RDW.4. According to the result of follow-up, we divided the patients into two groups: majoradverse cardiovascular events group and non major adverse cardiovascular events group.We did single factor analysis first, then the multivariate Logistic regression among themeaning factors in order to filter risk factors that influence the prognosis.Results:1.376patients fulfilling the criteria were enrolled, and grouped as either anelevated or non-elevated RDW using the median of RDW (12.9%). Studying their basicclinical, laboratory and auxiliary examination indicators, we found that white blood countlevel is correlated with RDW (simple correlation coefficient0.326, partial correlationcoefficient0.218) after adjusting age, hemoglobin, mean corpuscular hemoglobinconcentration, left ventricular ejection fraction, high sensitivity C-reactive protein, andserum creatinine and coronary lesions situation.2. During follow-up,146patients occurred major adverse cardiovascular events,including29patients with recurrent myocardial infarction,26patients with pectoris angina, 64patients with heart failure,27patients with cardiac death. The major adversecardiovascular events occurred more frequently among patients with higher RDW thanthose with lower RDW.3. Age, heart rate, red blood count, hemoglobin, mean corpuscular hemoglobinconcentration, RDW, left ventricular ejection fraction, white blood count, high sensitivityC-reactive protein and serum creatinine were risk factors of adverse outcomes showedfrom single factor analysis. Multivariate logistic regression analysis revealed that age,mean corpuscular hemoglobin concentration, RDW, left ventricular ejection fraction,hs-CRP and white blood count were associated with major adverse cardiovascular eventsduring follow-up.Conclusions:1. RDW was a valuable factor for predicting the prognosis of patientsundergoing primary PCI with ACS.2. Inflammation may be a mechanistic link between higher RDW and increasedadverse cardiovascular outcomes in patients undergoing primary PCI with ACS.3. Age, mean corpuscular hemoglobin concentration, RDW, left ventricular ejectionfraction, hs-CRP and white blood count were risk factors that can simultaneously predictthe prognosis of the patients undergoing primary PCI with ACS. |
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