Prognostic value of red cell distribution width in acute myocardial infarction

Relevance. Red cell distribution width (RDW), a marker of erythrocyte size variability, is considered a potential prognostic factor in cardiovascular diseases. Accurate risk assessment in acute myocardial infarction (MI) is crucial, yet identifying reliable prognostic markers remains essential for guiding clinical decisions and improving long-term survival. This study aims to investigate the prognostic value of RDW on admission for long-term mortality in patients with acute MI. Materials and methods. The prospective observational study included 577 MI patients who underwent coronary angiography within 24 hours of admission. Demographic data, vital signs, laboratory test data, and comorbidities were collected from the database. The clinical endpoint was 18‑month mortality. The associations between RDW, clinical parameters and clinical outcomes was evaluated using logistic regression and receiver operating characteristic (ROC) analysis. Results and Discussion. The median age of patients was 65 (interquartile range [IQR]: 56–74) years, 60.7% were male. The 18‑month mortality rate was 11.4% (n  =  66). Median RDW was 14.2% (IQR 13.5–15.0). RDW was correlated with age, history of coronary artery disease, previous MI, previous cerebrovascular accidents, atrial fibrillation, peripheral artery disease, hemoglobin, left ventricular ejection fraction and GRACE score. Patients with 18‑month mortality had significantly higher RDW values compared to survivors (15.0% vs. 14.1%, p  <  0.001). Higher RDW values were associated with an increased 18‑month mortality (quartile 1: 3.9%, quartile 2: 5.4%, quartile 3: 13.4%, quartile 4: 23.9%, p < 0.001). Univariate analysis revealed that RDW was associated with 18‑month mortality (odds ratio [OR]: 1.38; 95% confidence interval [CI]: 1.20–1.58, p < 0.001). Multivariate analysis revealed RDW as an independent predictor of 18‑month mortality (adjusted OR: 1.33, 95% CI: 1.12–1.58, p < 0.001). The area under the ROC curve of RDW was 0.708 (95% CI: 0.642–0.775, p < 0.001) for predicting 18‑month mortality. The optimal cutoff value of RDW to predict 18‑month mortality was 14.2% with a sensitivity of 78.8% and a specificity of 54.8%. Conclusion. Elevated RDW value on admission was associated with an increased risk of 18‑month mortality in patients with acute MI. RDW was an independent predictor of 18‑month mortality in patients with acute MI, highlighting its potential as a prognostic marker in this population.