Red cell distribution width is a predictor of ST resolution and clinical outcome following thrombolysis in acute ST elevation myocardial infarction

Abstract

Introduction: Red cell distribution width (RDW) has been shown to associate with adverse outcomes in various cardiovascular diseases. We aimed to explore the predictive value of RDW for resolution of the ST segment (STR) after thrombolytic therapy in patients with ST elevation myocardial infarction (STEMI). Methods: Patients with STEMI with indication for thrombolytic therapy were recruited from a university center between 2013 and 2015. A comprehensive laboratory investigation at the time of admission included measurement of RDW. Following thrombolysis ST segment resolution was assessed after 90 min. A positive response (STR >= 50%) was the primary endpoint. Secondary endpoints were major adverse cardiac events (MACE) defined as occurrence of acute heart failure, ventricular dysrhythmia beyond the first 24 h, cardiac arrest or death during hospitalization. Results: A total of 312 patients (271 male) with the mean age of 57.9 +/- 12.3 were enrolled. RDW on admission was 14.1 +/- 1.0% (range: 11.6-17.7%). STR was seen in 191 cases (61.2%). MACE occurred in 36 (11.5%) patients. The long-term mortality rate was 7.1% during the follow-up period of 7.7 +/- 3.2 months. Even after adjusting for co-morbid conditions, in multivariate model, baseline RDW, independently predicts STR (RR = 2.46, 95% CI 1.32-4.57, P = 0.005) and in hospital occurrence of MACE (RR = 3.17, 95% CI 1.23-8.46, p = 0.017). The cut-off values for RDW in predicting STR and MACE were 14.2% and 14.4%, respectively. Conclusion: An elevated baseline RDW could predict adverse outcomes and response to thrombolytic therapy in patients with STEMI. This extends our knowledge about RDW value in prognostication. Published by Elsevier Ltd.