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Clin Cardiol. 2013 Jun;36(6):336-41. doi: 10.1002/clc.22114. Epub 2013 Apr 8.

Incremental predictive value of red cell distribution width for 12-month clinical outcome after acute myocardial infarction.

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  • 1Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.



The incremental predictive value of red cell distribution width (RDW) for major adverse cardiac events (MACEs) has not been fully investigated in patients with acute myocardial infarction (AMI).


The aim of this study was to determine the incremental value of RDW to the established risk factors in predicting clinical outcomes after AMI.


Between November 2005 and January 2010, 1596 patients with AMI (1070 male; mean age, 64.5 ± 11.9 years) were analyzed in this study. Baseline levels of RDW were measured at the time of admission. The 12-month MACEs were defined as death and nonfatal MI.


The RDW levels were significantly higher in patients with 12-month MACEs (13.8 ± 1.3% vs 13.3 ± 1.2%, P < 0.001). In a Cox proportional hazards model, RDW (hazard ratio [HR]: 1.19, P = 0.016) was an independent predictor for 12-month MACEs. Adding RDW to established risk factors and hemoglobin levels significantly improved prediction for 12-month MACEs, as shown by the net reclassification improvement (0.297; P = 0.012) and integrated discrimination improvement (0.0143; P = 0.042). The likelihood ratio test showed that RDW added incremental predictive value to the combination of hemoglobin and established risk factors (P = 0.005). Patients were categorized into 4 groups according to quartiles of RDW at baseline. Adjusted HRs for 12-month MACEs were 1 (RDW ≤12.6%, reference), 4.24 (RDW 12.7%-13.1%, P = 0.01), 4.36 (RDW 13.2%-13.9%, P = 0.008), and 6.18 (RDW 13.2%-13.9%, P = 0.001), respectively.


In post-myocardial infarction patients, baseline RDW levels at admission could provide incremental predictive value to established risk factors for predicting 12-month MACEs.

© 2013 Wiley Periodicals, Inc.

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