Relation between red blood cell distribution width (RDW) and all-cause mortality at two years in an unselected population referred for coronary angiography
Introduction
Anemia has been shown to be a powerful and independent predictor of adverse cardiovascular outcomes in multiple patient populations [1], [2], [3], [4], [5], [6]. More recently RDW, a numerical measure of the variability in size of circulating erythrocytes, has also been shown to be a strong predictor of adverse outcomes in patients with heart failure [7] and in patients with prior myocardial infarction but no symptomatic heart failure at baseline [8], even after adjustment for hematocrit. Accordingly, we tested the hypothesis that higher values of RDW are associated with the risk of all-cause mortality in a broad and unselected population of male patients referred to coronary angiography for a variety of indications, including ACS.
Section snippets
Study design
This was an observational study derived from a cohort of patients prospectively entered into a database for the purpose of examining the prognostic significance of various plasma biomarkers in patients with known or suspected coronary artery disease. The study population and design have been previously described in detail elsewhere [9]. Briefly, 389 male patients undergoing coronary angiography for a variety of indications constituted the study population. Patients presenting with ST-segment
Baseline characteristics
A total of 389 patients constituted the study population. The baseline clinical, laboratory and angiographic characteristics of the study population stratified by the upper tertile of RDW values are shown in Table 1. Higher RDW values were seen in association with hypertension and CHF on presentation, while lower RDW values were seen in association with baseline use of beta blockers and statins. RDW was also negatively correlated with hemoglobin. In the entire study population, there was a
Discussion
The primary finding of this study was that increased RDW was a strong and independent predictor of mortality in an unselected population of males referred for coronary angiography. This association remained significant even after adjustment for a wide variety of clinically relevant covariates. These covariates included not only important laboratory and clinical parameters (such as hemoglobin and CHF on presentation), but also angiographic variables such as the extent of coronary artery disease
Acknowledgement
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [12].
References (12)
- et al.
Usefulness of anemia in men as an independent predictor of two-year cardiovascular outcome in patients presenting with acute coronary syndrome
Am J Cardiol
(2006) - et al.
Anemia is an independent predictor of mortality after percutaneous coronary intervention
J Am Coll Cardiol
(2004) - et al.
Hemoglobin level is an independent predictor for adverse cardiovascular outcomes in women undergoing evaluation for chest pain: results from the National Heart, Lung, and Blood Institute Women's Ischemia Syndrome Evaluation Study
J Am Coll Cardiol
(2004) - et al.
Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction
J Am Coll Cardiol
(2001) - 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) - et al.
C-reactive protein and other emerging blood biomarkers to optimize risk stratification of vulnerable patients
J Am Coll Cardiol
(2006)