Department of Cardiology, Shengjing Hospital of China Medical University, No.36, Sanhao Street, Heping District, Shenyang City, Liaoning Province, People's Republic of China.
Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province, China.
BMC Cardiovasc Disord. 2019 Jul 24;19(1):175. doi: 10.1186/s12872-019-1159-3.
In-stent restenosis remains an unresolved issue. Inflammation plays a pivotal role in the process of in-stent restenosis. Significant and positive associations were found between red blood cell distribution width (RDW) and inflammation. But whether there is a close relationship between higher RDW and in-stent restenosis is still not clarified.
This retrospective observational study investigated 214 consecutive patients with unstable angina pectoris who underwent successful percutaneous coronary interventions with drug-eluting stents. Patients were divided into three groups according to baseline RDW before percutaneous coronary interventions (low RDW group:≤12.5%; intermediate RDW group:> 12.5% and ≤ 13.5%; high RDW group:> 13.5%). The follow-up angiographies were routinely performed 9-12 months after the initial percutaneous coronary interventions. The multivariate logistic regression analysis was employed to determine the independent predictors of in-stent restenosis.
The in-stent restenosis rate was significantly higher in group with higher baseline RDW value (12.3, 19.7, 47.7% in low, intermediate, and high RDW groups respectively, P < 0.001). The baseline RDWs were significantly higher in patients with in-stent restenosis compared with those in patients without in-stent restenosis (13.7 ± 0.8% vs. 13.0 ± 0.8%, P < 0.001). For prediction of in-stent restenosis, the ROC (receiver operating characteristic) curve analysis demonstrated the optimal RDW cutoff value was 13.37 (sensitivity: 65.5%, specificity: 73.6%); the diagnosis cutoff value was 13.89 (sensitivity: 40.0%, specificity: 91.8%); the screening cutoff value was 12.99 (sensitivity: 83.6%, specificity: 49.1%). By multivariate logistic analysis, higher baseline RDW (odds ratio [OR], 5.179; 95% confidence interval [CI], 2.568 to 10.446; P<0.001) together with lower baseline indirect bilirubin (OR, 0.413; 95% CI, 0.305 to 0.559; P<0.001) and diabetes (OR, 4.077; 95% CI, 1.654 to 10.054; P = 0.002) were closely associated with in-stent restenosis at followup (11.1 ± 5.8 months).
The baseline RDW was closely associated with in-stent restenosis at follow-up. The patients with higher baseline RDW might have more chances to develop in-stent restenosis at followup.
支架内再狭窄仍然是一个未解决的问题。炎症在支架内再狭窄过程中起着关键作用。红细胞分布宽度（RDW）与炎症之间存在显著的正相关关系。但是，较高的 RDW 是否与支架内再狭窄密切相关仍不清楚。
这项回顾性观察性研究调查了 214 例因不稳定型心绞痛而行成功经皮冠状动脉介入治疗的患者，这些患者均植入药物洗脱支架。根据经皮冠状动脉介入治疗前的基线 RDW 将患者分为三组（低 RDW 组：≤12.5%；中 RDW 组：>12.5%且≤13.5%；高 RDW 组：>13.5%）。初始经皮冠状动脉介入治疗后 9-12 个月常规进行随访血管造影。采用多变量逻辑回归分析确定支架内再狭窄的独立预测因素。
基线 RDW 值较高的患者支架内再狭窄发生率明显较高（低、中、高 RDW 组分别为 12.3%、19.7%和 47.7%，P<0.001）。与无支架内再狭窄的患者相比，支架内再狭窄患者的基线 RDW 值明显更高（13.7±0.8% vs. 13.0±0.8%，P<0.001）。对于支架内再狭窄的预测，ROC（接受者操作特征）曲线分析表明最佳 RDW 截断值为 13.37（敏感性：65.5%，特异性：73.6%）；诊断截断值为 13.89（敏感性：40.0%，特异性：91.8%）；筛查截断值为 12.99（敏感性：83.6%，特异性：49.1%）。多变量逻辑分析显示，较高的基线 RDW（比值比[OR]，5.179；95%置信区间[CI]，2.568 至 10.446；P<0.001）和较低的基线间接胆红素（OR，0.413；95%CI，0.305 至 0.559；P<0.001）以及糖尿病（OR，4.077；95%CI，1.654 至 10.054；P=0.002）与随访时（11.1±5.8 个月）支架内再狭窄密切相关。
基线 RDW 与随访时的支架内再狭窄密切相关。基线 RDW 较高的患者在随访时发生支架内再狭窄的可能性更大。
