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Medicine (Baltimore). 2015 Nov;94(45):e1992. doi: 10.1097/MD.0000000000001992.

Hematological Parameters Improve Prediction of Mortality and Secondary Adverse Events in Coronary Angiography Patients: A Longitudinal Cohort Study.

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From the Experimental Cardiology Laboratory, University Medical Center Utrecht (CMG, HMDR, DPVDK, GP, IEH); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (CMG, DPVDK); Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore (DPVDK); Cardiovascular Research Institute (CVRI), National University Heart Centre (NUHCS), National University Health System, Singapore, Singapore (DPVDK); Department of Clinical Chemistry and Hematology (AH, MJTB, RHAVW, WWVS, IEH); Department of Cardiology, University Medical Center Utrecht (FWA, MV); Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (FWA); and Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK (FWA).


Prediction of primary cardiovascular events has been thoroughly investigated since the landmark Framingham risk score was introduced. However, prediction of secondary events after initial events of coronary artery disease (CAD) poses a new challenge. In a cohort of coronary angiography patients (n = 1760), we examined readily available hematological parameters from the UPOD (Utrecht Patient Oriented Database) and their addition to prediction of secondary cardiovascular events. Backward stepwise multivariable Cox regression analysis was used to test their ability to predict death and major adverse cardiovascular events (MACE). Continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) measures were calculated for the hematological parameters on top of traditional risk factors to assess prediction improvement. Panels of 3 to 8 hematological parameters significantly improved prediction of death and adverse events. The IDIs ranged from 0.02 to 0.07 (all P < 0.001) among outcome measures and the cNRIs from 0.11 to 0.40 (P < 0.001 in 5 of 6 outcome measures). In the hematological panels red cell distribution width (RDW) appeared most often. The multivariable adjusted hazard ratio of RDW per 1 standard deviation (SD) increase for MACE was 1.19 [1.08-1.32], P < 0.001. Routinely measured hematological parameters significantly improved prediction of mortality and adverse events in coronary angiography patients. Accurately indicating high-risk patients is of paramount importance in clinical decision-making.

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