The Clinical Relevance Of RDW Combined With GRACE Score In Evaluating Prognosis Of Patients With ACS

BackgroundAcute coronary syndrome(ACS)is a currently clinical common cardiovascular disease with acuteonset?rapidchanges and high mortality,which endangers the human health and life seriously.Making an early assessment of the prognosis of ACS will be helpful for the clinicians when they face to select treatment measures timely and effectively,which is benefit to improve the survival rate of the patients.At present,there are many markers and risk factors of ACS,such as age,hypertension,cardiac function classification,smoking,diabetes mellitus and impaired glucose tolerance.With the development of the research,some new risk factors and markers of ACS such as homocysteine,pregnancy associated plasma protein and red blood cell volume distribution width(RDW)have been proposed continuously.There have been a crowd of domestic and international studies to showthat RDW which is an index to reflect the heterogeneity of peripheral blood red cell volume can predict the prognosis of ACS more effectively.GRACE score which is a common risk score for ACS is advantageous for clinicians to choice appropriate treatment strategies to reduce mortality of the patients if it could be calculated early.Although there are more and more researches about the evaluation ofprognosis of ACS recent years,but it is rarely that combining RDW and GRACE score to predict the long-term prognosis of ACS.ObjectiveObjective to explore the the predictive value of RDW combined with GRACE score in evaluating the long-term prognosis of patients with acute coronary syndrome(ACS),and provide the theoretical basis for clinical application.MethodsWe performed an observational study of consecutive patients who have complete clinical datas and a definite diagnosis of ACS in The Second Hospital of Jilin University from January 2014 to December2014.We included 314 patients diagnosed with any of the ACS spectrum disorders,including unstable angina(UA)(152cases),non–ST-segment elevation myocardial infarction(NSTEMI)(59cases),and ST-segment elevation myocardial infarction(STEMI)(103cases).The general data,vital signs,past history and laboratory parameters were collected and recorded,and GRACE score was performed in all patients.The patients were followed up for 1 years(regular outpatient visits or telephone follow-up)to record the end of events(recurrent angina,myocardial infarction,heart failure,severe arrhythmia,sudden cardiac death).The patients were divided into high RDW group and low RDW group according to the RDW median level of patients,and were divided into high risk group,middle risk group and low risk group according to the GRACE score,the incidences of cardiac malignant events of different groups were compared.All datas were analyzed using SPSS statistical software.The measurement data using the mean and standard deviation(` x ± s)said that the measurement data between groups werecompared using t test,count data using X2 analysis,multivariate analysis using Logistic regression analysis.The use of receiver operating characteristic curve(ROC)analysis area GRACE score and RDW levels and their combination on the 1 year end events for patients with ACS predictive value to P<0.05 was considered statistically significant.Results1.The average RDW level in the event group was higher than that in the non event group((14.66±1.12)vs(11.41±1.01)%)and the mean value of GRACE score in the event group was higher than that in the non event group GRACE score(146.34±9.87vs118.46±9.38)whose differences were statistically significant(P < 0.05).2.Patients in the RDW?13.8% group were more than those in the RDW13.8% group,and the difference was statistically significant(P<0.05).3.When the high-risk group of GRACE score was compared with the middle group and the low risk group,there were significant differences in the number of cardiac events and the differences was statistically significant(P < 0.05).4.ROC curve was used to calculate the area under the curve,the area under the RDW curve was 0.700,the area under the GRACE curve was0.791,and the area under the curve of the combination of the two was0.812.Conclusions1.The level of RDW and the GRACE score were both not only valuable in predicting the prognosis of cardiac events in patients with ACS,but also positively correlated with the occurrence of cardiac events.2.The combination of RDW and GRACE score was more accurate in evaluating the long-term prognosis of patients with ACS.