Biomarkers for risk stratification in secondary cardiovascular prevention. A role of red blood cell distribution width and calcium score

• Published in: Atherosclerosis Vol. 246; pp. 57 - 62
• Main Authors: Oleksiak, Anna, Kruk, Mariusz, Lenarczyk, Ewelina, Pawelec, Magdalena, Rajska, Ewa, Wilkońska, Paulina, Dzielińska, Zofia, Demkow, Marcin, Witkowski, Adam, Pręgowski, Jerzy, Kępka, Cezary, Rużyłło, Witold
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.03.2016
• Subjects: Aged; Area Under Curve; Calcium score; Cardiovascular; Computed Tomography Angiography; Coronary Angiography - methods; Coronary artery disease; Coronary Artery Disease - blood; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Coronary Vessels - diagnostic imaging; Erythrocyte Indices; Erythrocytes; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction - etiology; Myocardial Infarction - prevention & control; Predictive Value of Tests; Proportional Hazards Models; RDW; Registries; Retrospective Studies; Risk Assessment; Risk Factors; ROC Curve; Secondary prevention; Secondary Prevention - methods; Severity of Illness Index; Time Factors; Treatment Outcome; Vascular Calcification - blood; Vascular Calcification - diagnostic imaging; Vascular Calcification - mortality; Vascular Calcification - therapy; Secondary prevention; Calcium score; RDW; Coronary artery disease
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2015.12.041

Abstract Background Patients with coronary artery disease (CAD) are considered as high risk in terms of secondary cardiovascular prevention. However, obviously the risk is not homogenous across the whole group. Red blood cell distribution width (RDW) has been recently related to adverse outcomes in patients with atherosclerosis. Calcium score (CaS) may be used for risk stratification in primary prevention. The value of these biomarkers for prediction of cardiovascular outcomes in patients with CAD is unknown. Methods The study group comprised 269 consecutive patients with significant stable CAD. The primary endpoint was a composite of death or nonfatal myocardial infarction. Results Median post-discharge follow up was 43.2 months (IQR39.2–48.6). The primary outcome was observed in 27 patients including 13 deaths and 14 nonfatal myocardial infarction. According to ROC analysis the best cut-off value for RDW for prediction of the primary event was 14% [(AUC) = 0.69; 95%CI:0.63–0.75; p = 0.0002] and for CaS was 603 [(AUC) = 0.66; 95%CI:0.60–0.72; p = 0.001]. According to multivariable Cox regression analysis both RDW>14% (HR 2.6; 95%CI:1.1–5.9) and CaS>603 (HR 2.3; 95%CI:1.1–5.1) were independently correlated to the primary outcome. Subsequently, patients were categorized into three risk subgroups: LOW: CaS≤603 and RDW≤14–124(46.1%), MID: either CaS>603 or RDW>14–104(38.7%), and HIGH - CaS>603 and RDW>14–41(15.2%) patients. The respective risk of events according to Kaplan–Meier analysis were 4.03%, 9.62%, and 29.27% (p < 0.0001). Conclusions RDW and calcium score may be predictors of future cardiovascular events in patients with significant CAD. They may be useful tools for risk stratification and may indicate patients suitable for more aggressive secondary prevention measures.