急性冠状动脉综合征患者红细胞分布宽度与六个月时预后的关联。

Association between red blood cell distribution width and outcomes at six months in patients with acute coronary syndromes.

作者信息

Nabais Sérgio, Losa Nuno, Gaspar António, Rocha Sérgia, Costa João, Azevedo Pedro, Basto Luís, Pereira Miguel Alvares, Correia Adelino

机构信息

Serviço de Cardiologia, Hospital de S. Marcos, Braga, Portugal.

出版信息

Rev Port Cardiol. 2009 Sep;28(9):905-24.

PMID:19998803

Abstract

BACKGROUND

Higher values of red ceildistribution width (RDW) may be associated with adverse outcomes in patients with heart failure and in those with stable coronary artery disease. We assessed the hypothesis that higher RDW values are associated with adverse cardiovascular outcomes in patients with acute coronary syndromes (ACS).

METHODS

We studied 1796 patients with ACS admitted to a coronary care unit. We analyzed clinical and laboratory characteristics, management, and outcomes of patients according to tertiles of baseline RDW. The primary outcome was death or myocardial infarction (MI) during six-month follow-up.

RESULTS

Patients with higher RDW values tended to be older, were more likely to be female and have a history of MI, and more often had renal dysfunction, anemia, and Killip class >I on admission (p < 0.05). Higher RDW values were associated with increased 6-month mortality (tertile 1: 8.2%; tertile 2: 10.9%; tertile 3: 15.5%; p = 0.001 for trend) and increased 6-month death/MI rates (tertile 1, 13.0%; tertile 2, 17.2%; tertile 3, 22.9%; p < 0.0001 for trend). An association between higher RDW and increased 6-month death/MI rates was found in patients with non-ST-elevation ACS (10.5% vs. 15.3% vs. 22.7%; p < 0.001 for trend), with a tendency in patients admitted with ST-elevation MI (15.1% vs. 19.1% vs. 23.1%; p = 0.053 for trend). After adjustment for baseline characteristics and treatment, higher RDW values remained independently associated with the study's primary composite outcome but not with all-cause death. Using the first tertile of RDW as reference, the adjusted odds ratio (OR) for 6-month death/MI among patients in the highest RDW tertile was 1.43 (95% confidence interval [CI], 1.00-2.05; p = 0.049). Using RDW as a continuous variable, the adjusted OR for 6-month death/MI was 1.16 (95% CI, 1.03-1.30; p = 0.017) per 1% increase in RDW.

CONCLUSIONS

RDW is an easily determined predictor of outcome after ACS. We found a graded independent association between higher RDW values and adverse outcomes in patients with ACS.

摘要

背景

较高的红细胞分布宽度（RDW）值可能与心力衰竭患者及稳定型冠状动脉疾病患者的不良预后相关。我们评估了较高的RDW值与急性冠状动脉综合征（ACS）患者不良心血管预后相关这一假说。

方法

我们研究了1796例入住冠心病监护病房的ACS患者。我们根据基线RDW的三分位数分析了患者的临床和实验室特征、治疗情况及预后。主要结局为6个月随访期间的死亡或心肌梗死（MI）。

结果

RDW值较高的患者往往年龄较大，更可能为女性且有MI病史，入院时更常出现肾功能不全、贫血及Killip分级>I（p<0.05）。较高的RDW值与6个月死亡率增加相关（第一三分位数：8.2%；第二三分位数：10.9%；第三三分位数：15.5%；趋势p=0.001），且与6个月死亡/MI率增加相关（第一三分位数，13.0%；第二三分位数，17.2%；第三三分位数，22.9%；趋势p<0.0001）。在非ST段抬高型ACS患者中发现较高的RDW与6个月死亡/MI率增加相关（10.5%对15.3%对22.7%；趋势p<0.001），ST段抬高型MI患者有此趋势（15.1%对19.1%对23.1%；趋势p=0.053）。在对基线特征和治疗进行调整后，较高的RDW值仍与研究的主要复合结局独立相关，但与全因死亡无关。以RDW的第一三分位数为参照，RDW最高三分位数患者6个月死亡/MI的校正比值比（OR）为1.43（95%置信区间[CI]，1.00 - 2.05；p = 0.049）。将RDW作为连续变量，RDW每增加1%，6个月死亡/MI的校正OR为1.16（95%CI，1.03 - 1.30；p = 0.017）。