Zhao Na, Mi Lan, Liu Xiaojun, Pan Shuo, Xu Jiaojiao, Xia Dongyu, Liu Zhongwei, Zhang Yong, Xiang Yu, Yuan Zuyi, Guan Gongchang, Wang Junkui
Department of Cardiovascular Medicine, Shaanxi Province People's Hospital, Xi'an, Shaanxi, China.
Department of Medical Affairs, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China.
PLoS One. 2015 Oct 15;10(10):e0140532. doi: 10.1371/journal.pone.0140532. eCollection 2015.
Global Registry of Acute Coronary Events (GRACE) risk score and red blood cell distribution width (RDW) content can both independently predict major adverse cardiac events (MACEs) in patients with acute coronary syndrome (ACS). We investigated the combined predictive value of RDW and GRACE risk score for cardiovascular events in patients with ACS undergoing percutaneous coronary intervention (PCI) for the first time. We enrolled 480 ACS patients. During a median follow-up time of 37.2 months, 70 (14.58%) patients experienced MACEs. Patients were divided into tertiles according to the baseline RDW content (11.30-12.90, 13.00-13.50, 13.60-16.40). GRACE score was positively correlated with RDW content. Multivariate Cox analysis showed that both GRACE score and RDW content were independent predictors of MACEs (hazard ratio 1.039; 95% confidence interval [CI] 1.024-1.055; p < 0.001; 1.699; 1.294-2.232; p < 0.001; respectively). Furthermore, Kaplan-Meier analysis demonstrated that the risk of MACEs increased with increasing RDW content (p < 0.001). For GRACE score alone, the area under the receiver operating characteristic (ROC) curve for MACEs was 0.749 (95% CI: 0.707-0.787). The area under the ROC curve for MACEs increased to 0.805 (0.766-0.839, p = 0.034) after adding RDW content. The incremental predictive value of combining RDW content and GRACE risk score was significantly improved, also shown by the net reclassification improvement (NRI = 0.352, p < 0.001) and integrated discrimination improvement (IDI = 0.023, p = 0.002). Combining the predictive value of RDW and GRACE risk score yielded a more accurate predictive value for long-term cardiovascular events in ACS patients who underwent PCI as compared to each measure alone.
全球急性冠状动脉事件注册研究（GRACE）风险评分和红细胞分布宽度（RDW）均能独立预测急性冠状动脉综合征（ACS）患者的主要不良心脏事件（MACE）。我们研究了RDW和GRACE风险评分对首次接受经皮冠状动脉介入治疗（PCI）的ACS患者心血管事件的联合预测价值。我们纳入了480例ACS患者。在中位随访时间37.2个月期间，70例（14.58%）患者发生了MACE。根据基线RDW水平（11.30 - 12.90、13.00 - 13.50、13.60 - 16.40）将患者分为三分位数。GRACE评分与RDW水平呈正相关。多因素Cox分析显示，GRACE评分和RDW水平均为MACE的独立预测因素（风险比分别为1.039；95%置信区间[CI] 1.024 - 1.055；p < 0.001；1.699；1.294 - 2.232；p < 0.001）。此外，Kaplan - Meier分析表明，MACE风险随RDW水平升高而增加（p < 0.001）。仅对于GRACE评分，MACE的受试者工作特征（ROC）曲线下面积为0.749（95% CI：0.707 - 0.787）。加入RDW水平后，MACE的ROC曲线下面积增至0.805（0.766 - 0.839，p = 0.034）。联合RDW水平和GRACE风险评分的增量预测价值显著提高，净重新分类改善（NRI = 0.352，p < 0.001）和综合判别改善（IDI = 0.023，p = 0.002）也表明了这一点。与单独使用每种指标相比，联合RDW和GRACE风险评分的预测价值能更准确地预测接受PCI的ACS患者的长期心血管事件。
