Relationship Between Red Blood Cell Distribution Width And Severity Of Coronary Artery Stenosis In Acute Non-ST-segment Elevation Myocardial Infarction

Obiectives:In this report,we examined the relationship between red blood cell distribution width(RDW)and severity of coronary artery stenosis in acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods: The study population included 321 NSTEMI patients in the First Affiliated Hospital of Soochow University during May 2012 and October 2017,243 males and 78 females,age from 33 to 81 years old,average age were 63.08±11.85 years old.ALL the patients recorded hypertension,dabetes meiiltus,smolking,height,weight,and coculated body mass index.Venous blood was drawm on empty stomach for each one to examine white blood cell(WBC),neutrophil,lymphocyte,hemoglobin(HB),platelet,RDW,platelet distribution width(PDW),creatinine(SCr),total choesterol(TC),high-density lipoproteinchelesterol(HDL-C),low-density lipoproteinchelesterol(LDL-C),triglyceride,fasting blood glucose(FBG),fibrinogen,hypersensitive C-reactive protein(hs CRP),uric acid(UA).Neutrophil to lymphocyte ratio(NLR)were coculated also.SYNTAX score was coculated after coronary angiography.According to the SYNTAX score,NSTEMI patients were divided into low coronary artery stenosis group(SYNTAX score≤22),medium coronary artery stenosis group(22<SYNTAX score≤32)and high coronary artery stenosis group(SYNTAX score>32).Results: After classifying based on SYNTAX score,there were differences in smolking(P=0.002),WBC(P=0.04),RDW(P<0.001),FBG(P=0.02),LDL-C(P=0.03),TC(P=0.007)and HDL-C(P=0.04).RDW in low coronary artery stenosis group,medium coronary artery stenosis group and high coronary artery stenosis group were(12.93±0.70)%,(13.11±0.63)% and(13.61±0.91)%.The medium coronary artery stenosis group(P=0.042)and high coronary artery stenosis group(P<0.001)had higher RDW levels,compared with low coronary artery stenosis group.High coronary artery stenosis group had higher RDW levels than medium coronary artery stenosis group(P=0.001).More than that,there was a good correlation between RDW and SYNTAX score(r=0.313,P<0.001).There were also correlations between RDW and HB(r=0.159,P=0.004),RDW and WBC(r=0.198,P<0.001),RDW and NLR(r=0.111,P=0.047),RDW and hs CRP(r=0.159,P=0.004),RDW and TC(r=0.113,P=0.043),RDW and SCr(r=0.161,P=0.004),RDW and UA(r=0.250,P<0.001),RDW and FBG(r=0.122,P=0.03).In these NSTEMI patients,smokers had higher RDW than no-smokers[(13.10±0.72)% vs.(12.94±0.78)%,P=0.037].The correlations between RDW and SYNTAX score in smokers and no-smokers were r=0.387,P<0.001 and r=0.231,P=0.008.Two of them had no significant difference(Z=1.50,P=0.13).A insignificant difference of RDW was found in these NSTEMI patients who with hypertension or without hypertension[(13.08±0.80)%vs.(12.96±0.58)%,P=0.19].The correlations between RDW and SYNTAX score in hypertension patients and non-hypertension patients were r=0.355,P<0.001 and r=0.210,P=0.04.Also two of them had no significant difference(Z=1.22,P=0.22).A insignificant difference of RDW was also found in these NSTEMI patients who with diabetes mellitus or without diabetes mellitus[(13.03±0.71)% vs.(13.10±0.83)%,P=0.45].The correlations between RDW and SYNTAX score in diabetes mellitus patients and non-diabetes mellitus patients were r=0.432,P<0.001 and r=0.266,P<0.001.Two of them had no significant difference(Z=-1.52,P=0.12).In multivarite analysis,RDW was observed to be an independent predictor for SYNTAX score >32(OR=2.705,95%CI 1.623-4.508,P<0.001).Finally,Receiver poeration characteristic curve(ROC curve)showed that area under curve was 0.717,95%CI 0.627-0.807,P<0.001(sensibility70.00%,specificity77.58%).RDW vaule of 13.44% was identified as the best effective cut-point in the SYNTAX scoer >32.Conculsions:1.There is a significant difference of RDW in three groups.HB,WBC,NLR,hs CRP,TC,SCr,UA and FBG are correlative to RDW.2.A good active correlation is found between RDW and SYNTAX score in NSTEMI patients.This correlation is always meaningful whether smoking,hypertension,or diabetes mellitus.But no signifcant difference of related coefficients is found about RDW and SYNTAX score in smoking NSTEMI and no-smoking NSTEMI patients.Same consequences are found in hypertension and non-hypertension NSTEMI patients,diabetes mellitus and non-diabetes mellitus patients.3.RDW is observed to be an independent predictor for SYNTAX score>32.ROC curve shows area under curve for RDW to predict SYNTAX score>32 was 0.717,95% CI 0.627-0.807,P<0.001(sensibility70.00%,specificity77.58%),and the cut-of point is 13.44%.