Gurbuz Orcun, Kumtepe Gencehan, Ozkan Hakan, Karal Ilker Hasan, Ercan Abdulkadir, Ener Serdar
Department of Cardiovascular Surgery, Balikesir University, School of Medicine, 10010, Balikesir, Turkey.
Department Of Cardiology, Bahcesehir University Faculty of Medicine, Istanbul, Turkey.
J Cardiothorac Surg. 2016 Apr 9;11:48. doi: 10.1186/s13019-016-0465-4.
Reports investigating the predictive value of red cell distribution width (RDW) on major cardiac and cardiovascular event (MACCE) following coronary artery bypass grafting (CABG) have major limitations, including lack of elimination of common factors affecting RDW levels, such as anemia. The purpose of this study is to identify the real effect of higher RDW level, free from the other factors, on MACCE following CABG.
Data of 500 consecutive, non-anemic patients (77.2 % male and mean age 63.05 ± 9.24) undergoing ONBHCAB between January 2007 and January 2010, were analyzed retrospectively.
Overall MACCE was 7.8 % of all cases. Mean follow-up was 66.5 ± 9.96 months. In multivariate Cox regression analysis, RDW (P = 0.022) remained the only independent predictor of MACCE and the ROC analyze revealed an RDW cut-off value of 13.95 % predicting MACCE. Therefore, patients were grouped on this cut-off value. There were 238 patients in the lower RDW group (Group 1) and 262 patients in the higher RDW group (Group 2). Kaplan-Meier survival analysis of freedom from MACCE revealed significantly lower event free survival in Group 2 (P < 0.001 by the log-rank test). Group 2 showed a higher MACCE incidence in 1 year (P = 0.030), in 3 years (P < 0.001) and in 6 years (P < 0.001). The long-term follow-up was similar regarding noncardiovascular mortality.
An RDW level greater than 13.95 % in hospital admission is independently associated with an increased incidence of MACCE after CABG. Physicians should be more aggressive in the management of these patients.
关于红细胞分布宽度（RDW）对冠状动脉旁路移植术（CABG）后主要心脏和心血管事件（MACCE）预测价值的研究报告存在重大局限性，包括缺乏消除影响RDW水平的常见因素，如贫血。本研究的目的是确定在排除其他因素的情况下，较高的RDW水平对CABG后MACCE的实际影响。
回顾性分析了2007年1月至2010年1月期间连续接受非体外循环冠状动脉搭桥术（ONBHCAB）的500例非贫血患者（男性占77.2%，平均年龄63.05±9.24岁）的数据。
总体MACCE发生率为所有病例的7.8%。平均随访时间为66.5±9.96个月。在多变量Cox回归分析中，RDW（P = 0.022）仍然是MACCE的唯一独立预测因素，ROC分析显示预测MACCE的RDW临界值为13.95%。因此，根据该临界值对患者进行分组。低RDW组（第1组）有238例患者，高RDW组（第2组）有262例患者。Kaplan-Meier生存分析显示，第2组无MACCE的生存情况明显较差（对数秩检验P < 0.001）。第2组在1年（P = 0.030）、3年（P < 0.001）和6年（P < 0.001）时的MACCE发生率较高。在非心血管死亡率方面，长期随访结果相似。
入院时RDW水平大于13.95%与CABG后MACCE发生率增加独立相关。医生应对这些患者采取更积极的管理措施。
