Vol 9, No 1 (2024)
Original article
Published online: 2023-12-22

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The impact of complete blood count-derived indices (RDW, PDW and NLR) on 4 years outcomes in patients after PCI with sirolimus-eluting stent, including complex high-risk index procedure (CHIP) patients

Maciej Tyczyński1, Adam Kern2, Patryk Buller3, Robert J. Gil4, Jacek Bil1
Medical Research Journal 2024;9(1):11-22.

Abstract

Introduction: The authors analysed red cell distribution width (RDW), platelet distribution width (PDW), and
the neutrophil-to-lymphocyte ratio (NLR) as potential predicting factors of adverse outcomes in patients
after percutaneous coronary intervention (PCI) at 48 months follow-up.

Material and methods: The authors gathered data on subjects who underwent PCI with a sirolimus-eluting
Alex Plus stent (Balton, Poland). They characterized the rate of major adverse cardiovascular events
(MACE) over a 4-year period, which encompassed cardiac death, myocardial infarction (MI), and target
lesion revascularization (TLR) depending on the RDW, PDW, and NLR values.

Results: Included were 218 patients (256 stents), among which were also identified 77 complex, high-risk
index procedure (CHIP) patients and 73 high bleeding risk (HBR) patients. The authors identified only RDW
as having a significant impact on long-term outcomes and only in the total population and CHIP patients.
The total population with RDW > 14.5% was characterized by higher age (67 ± 11 vs. 73 ± 10 years,
p < 0.01) and higher incidence of chronic kidney disease (14% vs. 39%, p < 0.01) as well as chronic
obstructive pulmonary disease (4% vs. 15%, p = 0.024). Interestingly, this group had a lower rate of ACS
(42% vs. 34%, p = 0.049). At 48 months in the total population with RDW > 14.5% of patients, the rates
of MACE, cardiac death, MI, and TLR were 26.8%, 19.5%, 9.8%, and 12.2%, respectively.

Conclusions: RDW > 14.5% correlated with a higher risk of cardiac death in the total population and
CHIP patients.

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References

  1. Lababidi H, Salerno PR, Wass SY, et al. The Global Burden of premature cardiovascular disease, 1990-2019. Int J Cardiol Cardiovasc Risk Prev. 2023; 19: 200212.
  2. Chigogidze M, Mantskava M, Sanikidze T, et al. Study of blood rheological parameters and NO in coronary artery disease patients with and without collaterals. Clin Hemorheol Microcirc. 2023; 84(2): 193–203.
  3. Sohn M, Lee JE, Ahn M, et al. Correlation of dynamic membrane fluctuations in red blood cells with diabetes mellitus and cardiovascular risks. Sci Rep. 2021; 11(7007).
  4. Moriya S, Wada H, Iwata H, et al. Red cell distribution width predicts long-term cardiovascular outcomes in patients with chronic coronary syndrome. Int Heart J. 2022; 63(6): 1041–1047.
  5. Ananthaseshan S, Bojakowski K, Sacharczuk M, et al. Red blood cell distribution width is associated with increased interactions of blood cells with vascular wall. Sci Rep. 2022; 12(1): 13676.
  6. Katamreddy A, Kokkinidis DG, Miles J, et al. Elevated red cell distribution width and cardiovascular mortality in ASCVD risk cohorts: National Health and Nutrition Examination Survey (NHANES III). Rev Cardiovasc Med. 2022; 23(2): 51.
  7. Dettori P, Paliogiannis P, Pascale RM, et al. Blood cell count indexes of systemic inflammation in carotid artery disease: current evidence and future perspectives. Curr Pharm Des. 2021; 27(18): 2170–2179.
  8. Mureșan AV, Tomac A, Opriș DR, et al. Inflammatory markers used as predictors of subclinical atherosclerosis in patients with diabetic polyneuropathy. Life (Basel). 2023; 13(9).
  9. Tudurachi BS, Anghel L, Tudurachi A, et al. Assessment of inflammatory hematological ratios (NLR, PLR, MLR, LMR and monocyte/hdl-cholesterol ratio) in acute myocardial infarction and particularities in young patients. Int J Mol Sci. 2023; 24(18).
  10. Arbel Y, Shacham Y, Finkelstein A, et al. Red blood cell distribution width (RDW) and long-term survival in patients with ST elevation myocardial infarction. Thromb Res. 2014; 134(5): 976–979.
  11. Hou H, Sun T, Li Ch, et al. An overall and dose-response meta-analysis of red blood cell distribution width and CVD outcomes. Sci Rep. 2017; 7: 43420.
  12. Su Ch, Liao LZ, Song Y, et al. The role of red blood cell distribution width in mortality and cardiovascular risk among patients with coronary artery diseases: a systematic review and meta-analysis. J Thorac Dis. 2014; 6(10): 1429–1440.
  13. Kern A, Gil RJ, Bojko K, et al. Platelet distribution width as the prognostic marker in coronary bifurcation treatment. Eur J Clin Invest. 2017; 47(7): 524–530.
  14. Tyczyński M, Kern A, Buller P, et al. Clinical outcomes and prognostic factors in complex, high-risk indicated procedure (CHIP) and high-bleeding-risk (HBR) patients undergoing percutaneous coronary intervention with sirolimus-eluting stent implantation: 4-year results. J Clin Med. 2023; 12(16).
  15. Achim A, Marc M, Ruzsa Z. Surgical turned-downed CHIP cases-can PCI save the day? Front Cardiovasc Med. 2022; 9: 872398.
  16. Marschall A, Martí Sánchez D, Ferreiro JL, et al. Outcomes prediction in complex high-risk indicated percutaneous coronary interventions in the older patients. Am J Cardiol. 2023; 205: 465–472.
  17. Shamkhani W, Moledina S, Rashid M, et al. Complex high-risk percutaneous coronary intervention types, trends, and outcomes according to vascular access site. Catheter Cardiovasc Interv. 2023; 102(5): 803–813.
  18. Bainey KR, Marquis-Gravel G, MacDonald BJ, et al. Short dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk patients: Systematic review and meta-analysis. PLoS One. 2023; 18(9): e0291061.
  19. Cimmino G, Gallinoro E, Di Serafino L, et al. Antiplatelet therapy in acute coronary syndromes. Lights and shadows of platelet function tests to guide the best therapeutic approach. Curr Vasc Pharmacol. 2020; 18(3): 262–272.
  20. Buszman PP, Michalak MJ, Pruski M, et al. Comparable vascular response of a new generation sirolimus eluting stents when compared to fluoropolymer everolimus eluting stents in the porcine coronary restenosis model. Cardiol J. 2016; 23(6): 657–666.
  21. Dobrolińska M, Gąsior P, Roleder T, et al. Short-term healing response after implantation of the thin-strut, fast-releasing sirolimus-eluting biodegradable polymer-coated Alex Plus stent: optical coherence tomography study. Postepy Kardiol Interwencyjnej. 2020; 16(2): 187–191.
  22. Chieffo A, Burzotta F, Pappalardo F, et al. Clinical expert consensus document on the use of percutaneous left ventricular assist support devices during complex high-risk indicated PCI: Italian Society of Interventional Cardiology Working Group Endorsed by Spanish and Portuguese Interventional Cardiology Societies. Int J Cardiol. 2019; 293: 84–90.
  23. Bass TA. High-risk percutaneous coronary interventions in modern day clinical practice: current concepts and challenges. Circ Cardiovasc Interv. 2015; 8(12): e003405.
  24. Urban P, Mehran R, Colleran R, et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Eur Heart J. 2019; 40(31): 2632–2653.
  25. Byun S, Choo EHo, Oh GC, et al. Temporal trends of major bleeding and its prediction by the Academic Research Consortium-High Bleeding Risk criteria in acute myocardial infarction. J Clin Med. 2022; 11(4): 988.
  26. Choi SY, Kim MH, Lee KM, et al. Comparison of performance between ARC-HBR criteria and PRECISE-DAPT score in patients undergoing percutaneous coronary intervention. J Clin Med. 2021; 10(12): 2566.
  27. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33): 3021–3104.
  28. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Circulation. 2018; 138(20): e618–e651.
  29. Marx N, Federici M, Schütt K, et al. 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023; 44(39): 4043–4140.
  30. Ryan TJ, Faxon DP, Gunnar RM, et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation. 1988; 78(2): 486–502.
  31. Farooq V, van Klaveren D, Steyerberg EW, et al. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II. Lancet. 2013; 381(9867): 639–650.
  32. Markovic Boras M, Brizic I, Mikulic I. The significance of red cell distribution width and homocysteine values in STEMI patients undergoing PCI in the population of Bosnia and Herzegovina. Eur Rev Med Pharmacol Sci. 2021; 25(10): 3791–3797.
  33. Bao D, Luo G, Kan F, et al. Prognostic value of red cell distribution width in patients undergoing percutaneous coronary intervention: a meta-analysis. BMJ Open. 2020; 10(9): e033378.
  34. Dai C, Chen Z, Qian J, et al. Red cell distribution width as a marker of periprocedural myocardial infarction in patients with elective percutaneous coronary intervention. J Cardiovasc Transl Res. 2021; 14(3): 449–456.
  35. Liao MT, Lai CL, Wang TC, et al. Red cell distribution width and mortality in patients undergoing percutaneous coronary intervention. Biomedicines. 2021; 10(1): 45.
  36. Bozorgi A, Khaki S, Mortazavi SH, et al. Effect of baseline red blood cell distribution width on short- and intermediate-term mortality of patients under primary percutaneous coronary intervention: a survival analysis. Crit Pathw Cardiol. 2016; 15(2): 69–74.
  37. Ling Y, Wang W, Fu C, et al. The relationship between red cell distribution width and residual SYNTAX scores in st-segment elevation myocardial infarction patients after percutaneous coronary intervention. Dis Markers. 2021; 2021: 3281837.
  38. Breen TJ, Bennett CE, Van Diepen S, et al. The Mayo Cardiac Intensive Care Unit Admission Risk Score is associated with medical resource utilization during hospitalization. Mayo Clin Proc Innov Qual Outcomes. 2021; 5(5): 839–850.
  39. Zhang B, Xu Y, Huang X, et al. Red blood cell distribution width: a risk factor for prognosis in patients with ischemic cardiomyopathy after percutaneous coronary intervention. J Clin Med. 2023; 12(4).
  40. Xiao LJ, Liu JL, Pan NN, et al. The predictive value of red cell distribution width and red cell distribution width to erythrocyte count ratio for adverse cardiovascular events during the hospitalization of patients of ST-segment elevation myocardial infarction. Clin Lab. 2020; 66(7).
  41. Pan R. Relationship of red cell volume distribution width and n-terminal pro-brain natriuretic peptide with severity and prognosis of patients with acute coronary syndrome receiving percutaneous coronary intervention. Clin Lab. 2020; 66(4).
  42. Machado GP, de Araujo GN, Carpes CK, et al. Long-term pattern of red cell distribution width in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Crit Pathw Cardiol. 2020; 19(1): 43–48.
  43. Wu TT, Zheng YY, Hou XG, et al. Red blood cell distribution width as long-term prognostic markers in patients with coronary artery disease undergoing percutaneous coronary intervention. Lipids Health Dis. 2019; 18(1): 140.
  44. Isik T, Kurt M, Tanboga I, et al. The impact of admission red cell distribution width on long-term cardiovascular events after primary percutaneous intervention: A four-year prospective study. Cardiol J. 2016; 23(3): 281–288.
  45. Ebina T, Tochihara S, Okazaki M, et al. Impact of red blood cell distribution width and mean platelet volume in patients with ST-segment elevation myocardial infarction. Heart Vessels. 2022; 37(3): 392–399.
  46. Lin G, Dai C, Xu K, et al. Predictive value of neutrophil to lymphocyte ratio and red cell distribution width on death for ST segment elevation myocardial infarction. Sci Rep. 2021; 11(1): 11506.
  47. Karakas MS, Korucuk N, Tosun V, et al. Red cell distribution width and neutrophil-to-lymphocyte ratio predict left ventricular dysfunction in acute anterior ST-segment elevation myocardial infarction. J Saudi Heart Assoc. 2016; 28(3): 152–158.
  48. Weng Y, Peng Y, Xu Y, et al. The ratio of red blood cell distribution width to albumin is correlated with all-cause mortality of patients after percutaneous coronary intervention — a retrospective cohort study. Front Cardiovasc Med. 2022; 9: 869816.
  49. Xiu WJ, Zheng YY, Wu TT, et al. Hemoglobin-to-red-cell distribution width ratio is a novel predictor of long-term patient outcomes after percutaneous coronary intervention: a retrospective cohort study. Front Cardiovasc Med. 2022; 9: 726025.
  50. Paolisso P, Bergamaschi L, Santulli G, et al. Infarct size, inflammatory burden, and admission hyperglycemia in diabetic patients with acute myocardial infarction treated with SGLT2-inhibitors: a multicenter international registry. Cardiovasc Diabetol. 2022; 21(1): 77.