The Correlation Between Red Cell Distribution Width And Coronary Thrombus Burden In Patients With Acute Myocardial Infarction

objective: To investigate the correlation between red cell distri bution width(RDW)and coronary thrombus burden in patients with acute myocardial infarction(including acute ST-segment elevation myocardial infarction(STEMI)and non-ST-segment elevation myocardial infarction(NSTEMI).Methods :Ninety-six patients with acute myocardial infarction from February 2017 to July 2018 in the Department of Cardiology of the First People’s Hospital of Shuangliu District were selected,including STEMI(73 patients)who underwent primary percutaneous coronary interventi on(PPCI)and NSTEMI(23 patients)with GRACE score(>140),or with cardiogenic shock and intractable chest pain,who underwent interventional therapy within 24 hours.Four patients with STEMI died and one patient only received emergency angiography.Four patients with NSTEMI only u nderwent angiography and one patient with NSTEMI refused to receive interventional therapy.All of the 11 patients were excluded.A total of 85 patients(67 STEMI and 18 NSTEMI)were included in the study as the experimental group,and 85 patients with chest pain symptoms but comp letely normal coronary angiography were selected as the control group.In the experimental group,300 mg aspirin enteric-coated tablets,180 mg tegrillo and 20 mg rosuvastatin calcium were given at admission.The patients in the operation were given thromboembolic aspiration and tirofiban treatment according to the condition of coronary thrombosis,and the patients after the operation continued to receive standardized treatment of co ronary heart disease.Record the general characteristics of all patients,such as sex,age,smoking,hypertension,diabetes mellitus and so on.Immediately after admission,peripheral venous blood was collected.Blood routine,RDW,C-reactive protein,CK-MB,troponin(cTnT),brain natriuretic peptide(BNP),liver and kidney function were measured by the laboratory.On the morning of the second day,fasting venous blood was taken and plasma total cholesterol(TC),triglyceride(TG),low density lipoprotein c holesterol(LDL-C)and high density lipoprotein cholesterol(HDL-C)were measured.One week after operation,left ventricular ejection fraction(LVEF)was measured by echocardiography.According to the results of cor onary angiography and interventional therapy,TIMI thrombus classification and TIMI blood flow score were performed.Firstly,the difference of RDW between the experimental group(acute myocardial infarction group) and the control group(normal coronary angiography group)was compared.Then the experimental group was divided into low RDW group(RDW < 13.7%)and high RDW group(RDW≥13.7%)according to the average RDW value.The difference of CK-MB and cTNT between the two groups was compared.According to TIMI thrombus classification,the patients were divided into low thrombus load group and high thrombus load group,and the difference between the two groups in RDW value and high RDW ratio was compared.According to TIMI blood flow score,the patients were divided into non-recanalization group and reperfusion group,and the difference between the two groups in high RDW was compared.Results: 1.Compared with the control group,the proportion of male,smoking and hypertension in the experimental group was significantly higher,while the proportion of hemoglobin,RDW,creatinine,triglyceride and LDL-cholesterol in the experimental group was significantly higher than that in the control group,and the proportion of HDL-cholesterol in the control group was lower,there are significant difference(P< 0.05).2.The experimental group was divided into high RDW group(RDW ≥ 13.7%,36 cases)and low RDW group(RDW < 13.7%,47 cases).There was no significant difference in age,sex,smoking rate,diabetes proportion,h emoglobin,platelet,creatinine and blood lipid between the two groups(P>0.05).In high RDW group,hypertension was more than low RDW group,CK-MB and troponin were significantly higher than those in low RDW group(P < 0.05).The EF in high RDW group was significantly lower than that in low RDW group(P< 0.05).Although there was no signifi cant difference in BNP,the value in the high RDW group was higher than the low RDW group.3.The experimental group was divided into high thrombus group(TIMI thrombus grade 4-5,46 cases)and low thrombus group(TIMI thrombus grade 0-3,39 cases).Age,sex,smoking,proportion of hypertension and diabetes,hemoglobin,platelet,creatinine,triglyceride,total cholesterol,high density lipoprotein cholesterol,low density lipop rotein cholesterol,CK-MB,troponin,NT-proBNP and LVEF were compared between the two groups.There was no significant difference.In the high thrombus group,the RDW value(P=0.001)and the ratio of high RDW [P=0.020] were significantly higher than those in the low thrombus group,and multivariate regression analysis showed that RDW was an independent predictor of high thrombus load in coronary artery(OR: 2.081,95% CI: 1.311-3.303,P=0.002);the ratio of high RDW in the TIMI gro up without reperfusion was significantly higher than that in the reperfusion group(P=0.027,P<0.05).4.ROC curve analysis showed that RDW(≥13.7%)had a sensitivity of 60.87% and a specificity of 82.05% in predicting high thrombotic load of coronary artery in acute myocardial infarcti on.Conclusion: 1.The RDW in patients with acute myocardial infarction was significantly higher than that in patients with normal coronary angiography.2.RDW is associated with CK-MB,cTNT and LVEF.Compared with low RDW group,the values of CK-MB,cTNT in high RDW group are significantly higher and EF is significantly lower,which can assist in risk early warning and assessment of the severity of the disease.3.High RDW is associated with high thrombus burden of coronary artery and low myocardial perfusion in patients with acute myocardial infarction.It can guide early pretreatment,reduce the risk of slow blood flow and no-reflow during and after operation,reduce complications and improve the prognosis of patients.