Red cell distribution width to predict all-cause mortality in patients evaluated in the hospital for acute myocardial infarction.
Gildeh E, Nowak R, Allen S, Jacobsen G, and McCord J. Red cell distribution width to predict all-cause mortality in patients evaluated in the hospital for acute myocardial infarction. J Gen Intern Med 2018; 33(2):328-329.
J Gen Intern Med
Background: Increased Red Cell Distribution Width (RDW) is associ-ated with increased mortality, primarily in those with heart failure. Prior studies have been limited by short-term follow-up. We sought to evaluate RDW in patients presenting with possible acute myocardial infarction (AMI) to determine association with all-cause mortality. Methods: Patients evaluated for possible AMI in the hospital between January and May 1999 were included. Presenting RDW, characteristics and outcomes were recorded via chart review, phone calls and review of the social security death registry over 5 years. Results: A total of 929 patients were collected. There were 65 (7%) AMIs. Our patients average age was 62.4 ± 16.4 with 82% being black and 46% male. RDW was higher in non-survivors vs. survivors at discharge (15.2 ± 2.3 vs 14.3 ± 2.3, p=0.005), 30 days (15.6 ± 2.4 vs. 14.3 ± 2.3, p< 0.001) and 5 years (15.3 ± 2.6 vs. 13.8 ± 1.7, p< 0.001). Mortality at 5 years is shown by RDW tertiles (Figure 1). Multivariate logistic regression analysis of RDW values (controlled for age, gender, race, comorbidities and family history) showed a hazard ratio for mortality at discharge of 1.149 (95% CI 0.996 to 1.325, p=0.057), 30 days of 1.216 (95% CI 1.092 to 1.355, p< 0.001) and 5 years of 1.216 (95% CI 1.171 to 1.262, p< 0.001). Conclusions: In patients evaluated for AMI, elevated RDW is independently associated with increased mortality at 30 days and 5 years. Further research into its utility in risk stratification and the mechanism by which RDW is associated with increased mortality is warranted. [Figure Presented].