Red Cell Distribution Width (RDW) prognostic value in patients with Acute Coronary Syndrome (ACS) has been well validated whereas that of Platelet Distribution Width (PDW) is less well known.
Objectives:
Investigate the incremental prognostic value, on top of GRACE risk score, of a new variable resulting from the combination of RDW and PDW.
Methods:
Consecutive patients with ACS. Complete blood count, with RDW and PDW, was obtained. Primary endpoint was one-year all-cause mortality and Cox regression models were used to measure the influence of RDW and PDW on patients’ survival time. A new combination categorical variable (RDW/PDW) was created with both discretized RDW and PDW and logistic regression models were used. Predictive value and discriminative ability of the model with GRACE risk score alone and of the model with inclusion of RDW/PDW was assessed.
Results:
We included 787 patients. Hospital and one-year mortality rates were 5.1% and 7.8%, respectively. Both continuous RDW and PDW were independent predictors of death. The best cut-off for RDW was 13.9%, and 14.5% for PDW. Inclusion of RDW/PDW in a model with GRACE risk score improved the AUC from 0.81 (95% CI 0.75–0.86) to 0.84 (95% CI 0.79–0.90) (p=0.024) with an improvement in total NRI (56%) and IDI (0.048).
Conclusions:
Simple markers such as RDW and PDW can be useful in risk stratification of death after ACS. Combining both markers with GRACE risk score improved the predictive value for all-cause mortality and reduced the estimated risk of those who did not die.
FelkerGMAllenLAPocockSJ. on behalf of CHARM Investigators. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke databank. J Am Coll Cardiol2007; 50: 40–47.
2.
TonelliMSacksFArnoldM. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary diseases. Circulation2008; 117: 163–168.
3.
UyarelHErgelenMCicekG. Red cell distribution width as a novel prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction. Coron Artery Dis2011; 22: 138–144.
4.
AzabBTorbeyEHatoumH. Usefulness of red cell distribution width in predicting all-cause long-term mortality after non-ST-elevation myocardial infarction. Cardiology2011; 119: 72–80.
5.
NabaisSLosaNGasparA. Association between red blood cell distribution width and outcomes at six months in patients with acute coronary syndromes. Rev Port Cardiol2009; 28: 905–924.
6.
PoludasuSMarmurJDWeedonJ. Red cell distribution width (RDW) as a predictor of long-term mortality in patients undergoing percutaneous coronary intervention. Thromb Haemost2009; 102: 581–587
7.
CavusogluEChopraVGuptaA. Relation between red blod cell dsitribution width (RDW) and all-cause mortality at two years in an unselected population referred for coronary angiography. Int J Cardiol2010; 141: 141–146.
8.
KhandekarMMKhuranaASDeshmukhSD. Platelet volume indices in patients with coronary artery disease and acute myocardial infarction: an Indian scenario. J Clin Pathol2006; 59: 146–149.
9.
VagdatliCGourariELazaridouE. Platelet distribution width: a simple, practical and psecific marker of activation of coagulation. Hippokratia2010; 14: 28–32.
10.
FoxKADabbousOHGoldbergRJ. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ2006; 333: 1091–1094.
11.
CockcroftDWGaultMH. Prediction of creatinine clearance from serum creatinine. Nephron1976; 16: 31–41.
12.
DeLongERDeLongDMClarke-PearsonDL. Comparing the areas under two or more correlated receiver operating characteristic cruves: a nonparametric approach. Biometrics1988; 44: 837–845.
13.
PencinaMJD’AgostinoRBSteyerbergEW. Extension of net reclassification improvement calculations to measure usefulness of new biomarkers. Statistics in Medicine2011; 30: 11–21.
14.
R Core Team R: A language and environment for statistical computing. R Foundation for Statistical Computing. 2013. Vienna, Austria. ISBN: 3-900051-07-0, http://.R-project.org/
15.
GonçalvesSFerreira SantosJAmadorP. Impact of red blood cell distribution width on risk for bleeding events in patients with non-ST elevation acute coronary syndrome. Rev Port Cardiol2013; 32: 27–33.
16.
CavusogluEChopraVGuptaA. Usefulness of anemia in men as an independent predictor of two-year cardiovascular outcome in patients presenting with acute coronary syndrome. Am J Cardiol2006; 98: 580–584.
17.
LeePCKiniASAhsanC. Anemia is an independent predictor of mortality after percutaneous coronary intervention. J Am Coll Cardiol2004; 44: 541–546.
18.
O’MearaEClaytonTMcEntegartMB, on behalf of CHARM Investigators. Clinical correlates and consequences of anemia in a broad spectrum of patients with heart failure: results of the CHARM Program. Circulation2006; 113: 986–994.
19.
DabbahSHammermanHMarkiewiczW. Relation between red cell distribution width and clinical outcomes after acute myocardial infarction. Am J Cardiol2010; 105: 312–317.
20.
IsikTKurtMAyhanE. The impact of admission red cell distribution width on the development of poor myocardial perfusion after primary percutaneous intervention. Atherosclerosis2012; 224: 143–149.
21.
TsimikasSWillersonJTRidkerPM. C-reactive protein and other emerging blood biomarkers to optimize risk stratification of vulnerable patients. J Am Coll Cardiol2006; 47: C19–C31.
22.
WeissGGoodroughLT. Anemia of chronic disease. N Engl J Med2005; 352: 1011–1028.
23.
PierceCNLarsonDF. Inflammatory cytokine inhibition of erythropoesis in patients implanted with a mechanical circulatory assist device. Perfusion2005; 20: 85–90.
24.
RidkerPMRifaiNClearfieldM. Measurement of C-reactive protein for the targeting of ebatin therapy in the primary prevention of acute coronary events. N Engl J Med2001; 344: 1959–1965.
25.
LippiGTargherGMontagnanaM. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med2009; 133: 628–632.
26.
ForheczZGombosTBorgulyaG. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythopoiesis, inflammation, renal function, and nutritional state. Am Heart J2009; 158: 659–666.
27.
Pascual-FigalDABonaqueJCRedondoB. Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients. Eur J Heart Fail2009; 11: 840–846.
28.
Al-NajjarYGoodeKMZhangJ. Red cell distribution width: an inexpensive and powerful prognostic marker in heart failure. Eur J Heart Fail2009; 11: 1155–1162.
29.
FerrarioMMassaMRostiV. Early haemoglobin-independent increase of plasma erythropoietin levels in patients with acute myocardial infarction. Eur Heart J2007; 28: 1805–1813.
30.
SembaRDPatelKYFerrucciL. Serum antioxidants and inflammation predict red cell distribution width in older women: the Women’s Health and Aging Study I. Clin Nutr2010; 29: 600–604.
31.
AllenLAFelkerGMMehraMR. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail2010; 16: 230–238.
32.
MassonSLatiniRAnandIS. On behalf of Val-HeFT Investigators. Prognostic value of changes in N-terminal pro-brain natriuretic peptide in Val-HeFT (Valsartan Heart Failure Trial). J Am Coll Cardiol2008; 52: 997–1003.
33.
TripMDCatsVKvan CapelleFL. Platelet hyperreactivy and prognosis in survivors of myocardial infarction. N Engl J Med1990; 322: 1549–1554.
34.
ThompsonCBEatonKAPrinciottaSM. Size-dependent platelet subpopulation: relationship of platelet volume to ultrastructure, enzymatic activity and function. Br J Haematol1982; 50: 509–520.
35.
CelikTKayaMAkpekM. Predictive value of admission platelet volume indices for in-hospital major adverse cardiovascular events in acute ST-segment elevation myocardial infarction. Angiology2013Dec3. (Epub ahead of print). PMID: 24301422. DOI: 10.1177/0003319713513493.
36.
JagroopIAClatworthyILewinJ. Shape change in human platelets: measurement with a channelyzer and visualization by electron microscopy. Platelets2000; 11: 28–32.
37.
VagdatliEGounariELazaridouE. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia2010; 14: 28–32.
38.
StohlawetzPJDzirloLHergovichN. Effects of erythropoietin on platelet reactivity and thrombopoiesis in humans. Blood2000; 95: 2983–2989.
39.
HuczekZKochmanJFilipiakKJ. Mean platelet volume on admission predicts impaired reperfusion and long-term mortality in acute myocardial infarction treated with primary percutaneous coronary intervention. J Am Coll Cardiol2005; 46: 284–290.
40.
MassbergSSchulzCGawazM. Role of platelets in the pathophysiology of acute coronary syndrome. Semin Vasc Med2003; 3: 147–162.
41.
ChuSGBeckerRCBergerPB. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost2010: 8: 148–156.
42.
Varastheh-RavanHRAli-Hassan-SayeghSShokranehS. Relationship of admission mean platelet volume platelet distribution width and white blood cells with ST resolution in patients with acute ST segment elevation myocardial infarction treated with streptokinase without history of previous cardiovascular surgery. Prespect Clin Research2013; 4: 125–129.
43.
MichaelsADGibsonCMBarronHV. Microvascular dysfunction in acute myocardial infarction: focus on the roles of platelets and inflammatory mediators in the no-reflow phenomenon. Am J Cardiol2000; 85(5A): 50B–60B.
44.
RoccaBSantilliFPitocoD. The recovery of platelet cyclooxygenase activity explains interindividual variability in responsiveness to low-dose aspirin in patients with and without diabetes. J Thromb Haemost2012; 10: 1220–1230.
45.
RechcinskiTJasinskaAForysJ. Prognostic value of platelet indices after acute myocardial infarction treated with primary percutaneous coronary intervention. Cardiol J2013; 20: 491–498.
46.
CetinMBakirciEMBaysalE. Increased platelet distribution width is associated with ST-segment elevation myocardial infarction and thrombolysis failure. Angiology2014Feb12. (Epub ahead of print). PMID: 24526792. DOI: 10.1177/0003319713520068.
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