Relation of Red Cell Distribution Width to Glucose Metabolism and Adverse Long-Term Prognosis in Patients with Acute Coronary Syndrome

Figures & data

Table 1 Baseline Characteristics of 448 Patients with ACS According to the RDW Content Tertiles

Variable	Low RDW	Medium RDW	High RDW	P value
	11.50–12.80	12.90–13.50	13.55–17.10
	n=149	n=164	n=135
RDW, %	12.41±0.30	13.21±0.20	14.29±0.75	<0.01
Age, year	58.57±9.61	60.00±10.30	62.96±10.81	<0.01
Male sex, %	117 (78.5)	136 (82.9)	99 (73.3)	0.13
BMI, kg/m^2	24.76±3.17	25.23±3.03	24.73±3.81	0.47
Smoking, %	77 (51.7)	103 (62.8)	73 (54.1)	0.11
Diabetes, %	34 (22.8)	28 (17.1)	27 (20.0)	0.45
Hypertension, %	71 (47.7)	90 (54.9)	73 (54.1)	0.39
Family history, %	57 (38.3)	77 (47.0)	48 (35.6)	0.11
Past MI, %	21 (14.1)	31 (18.9)	21 (15.6)	0.50
Past PCI or CABG, %	32 (21.5)	32 (19.5)	28 (20.7)	0.39
HR, bpm	69.48±12.47	72.56±18.02	70.73±15.23	0.10
SBP, mmHg	126.34±19.58	125.49±18.08	127.36±19.05	0.89
DBP, mmHg	77.67±11.63	78.07±11.70	78.26±12.03	0.97
Ejection fraction, %	57.39±11.70	57.55±12.73	60.05±12.10	0.10
WBC, K/μL	148.06±1721.80	391.75±2824.30	325.65±2574.95	0.46
RBC, K/μL	17.30±124.69	35.76±239.93	13.03±72.84	0.80
PLT, K/μL	192.18±58.49	190.98±65.88	188.68±102.20	0.10
HGB, g/L	139.48±13.99	141.85±16.12	134.17±20.95	<0.01
AST, U/L	48.54±54.77	53.36±63.23	59.76±67.35	0.13
ALT, U/L	39.59±35.78	34.79±26.91	34.15±23.88	0.61
BUN, mmol/L	4.71±1.54	4.69±1.26	5.24±1.58	<0.01
Cre, umol/L	66.41±18.46	70.82±16.25	70.92±21.17	0.03
TC, mg/dL	3.89±0.91	3.81±0.91	3.73±0.95	0.39
TG, mg/dL	1.77±1.39	1.76±1.15	1.49±0.73	0.18
HDL-C, mg/dL	0.94±0.23	0.91±0.21	0.91±0.23	0.70
LDL-C, mg/dL	2.23±0.76	2.24±0.85	2.20±0.85	0.90
HbA1c, %	6.69±1.73	6.36±1.26	6.29±1.04	0.86
FBG, mmol/L	6.84±2.65	6.21±2.19	6.21±2.29	0.02
hsCRP, mg/dL	2.17±2.09	2.81±2.61	2.53±2.55	0.24
CKMB, U/L	34.56±60.10	37.17±54.89	43.67±58.93	0.11
Pro-BNP, pg/mL	826.45±1752.38	1114.38±2237.17	1504.54±3573.74	0.01
Medication at discharge
β-Blocker, %	135 (90.6)	145 (88.4)	117 (86.7)	0.58
ACEI/ARB, %	133 (89.3)	155 (94.5)	120 (88.9)	0.15
Statin, %	144 (96.6)	161 (98.2)	134 (99.3)	0.29
CCB, %	27 (18.2)	45 (27.4)	27 (20.0)	0.11
DAPT, %	148 (99.3)	163 (99.4)	133 (98.5)	0.68
ACS type
UA, %	109 (73.2)	114 (69.5)	93 (68.9)	0.65
NSTEMI, %	11 (7.4)	20 (12.2)	13 (9.6)
STEMI, %	29 (19.5)	30 (18.2)	29 (21.5)

Note: Data are presented as mean±SD or number (%).

Abbreviations: ACS, acute coronary syndrome; RDW, red cell distribution width; BMI, body mass index; MI, myocardial infarction; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; HR, heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure; WBC, white blood cell; RBC, red blood cell; PLT, platelet; HGB, hemoglobin; AST, aspartate aminotransferase; ALT, alanine aminotransferase; BUN, blood urea nitrogen; Cre, creatinine; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; HbA1c, hemoglobin A1c; FBG, fasting blood glucose; hsCRP, high sensitivity C reactive protein; CKMB, creatine kinase isoenzyme; Pro-BNP, N-terminal pro-brain natriuretic peptide; ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; CCB, calcium channel antagonist; DAPT, dual antiplatelet therapy; UA, unstable angina; NSTEMI, non-ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction.

Table 2 Linear Regression Analysis Between FBG and RDW

Variable	Coefficient	95% CI		SEM	P value
Unadjusted
FBG	−0.042	−0.075	−0.008	0.017	0.016
Adjusted
FBG	−0.050	−0.099	−0.002	0.025	0.040
HbA1c	−0.020	−0.104	−0.064	0.043	0.639
Age	0.010	0.001	0.019	0.005	0.023
HGB	−0.006	−0.011	−0.001	0.003	0.027
BUN	0.071	−0.004	0.146	0.038	0.063
Cre	0.002	−0.004	0.007	0.003	0.571
Pro-BNP	3.205*10-5	<0.001	<0.001	<0.001	0.093

Abbreviations: FBG, fasting blood glucose; RDW, red cell distribution width; CI, confidential interval; SEM, standard estimated error; HbA1c, hemoglobin A1c; HGB, hemoglobin; BUN, blood urea nitrogen; Cre, creatinine; Pro-BNP, N-terminal pro-brain natriuretic peptide.

Figure 1 Linear regression analysis of the relationship between FBG and RDW in whole patients with ACS after PCI.

Abbreviations: FBG, fasting blood glucose; RDW, red cell distribution width; ACS, acute coronary syndrome; PCI, percutaneous coronary intervention.

Table 3 Baseline Characteristics of 448 Patients with ACS According to the FBG Content Median

Variable	Low FBG	High FBG	P value
	3.02–5.65	5.66–18.93
	n=225	n=223
FBG, mmol/L	4.89±0.49	7.98±2.57	<0.01
Age, year	59.25±10.44	61.59±10.18	0.02
Male sex, %	176 (78.2)	176 (78.9)	0.86
BMI, kg/m^2	25.04±3.43	24.82±3.18	0.50
Smoking, %	134 (59.6)	119 (53.4)	0.19
Diabetes, %	16 (7.1)	73 (32.7)	<0.01
Hypertension, %	122 (54.2)	112 (50.2)	0.40
Family history, %	90 (40.0)	92 (41.3)	0.79
Past MI, %	39 (17.3)	34 (15.2)	0.55
Past PCI or CABG, %	45 (20.0)	47 (21.1)	0.96
HR, bpm	69.15±12.47	72.84±17.94	0.03
SBP, mmHg	126.11±17.69	126.57±20.01	0.97
DBP, mmHg	77.80±11.21	78.20±12.29	0.71
Ejection fraction, %	60.41±11.51	56.10±12.61	<0.01
WBC, K/μL	100.73±1403.07	482.94±3131.33	0.01
RBC, K/μL	6.24±5.81	39.69±236.43	0.22
PLT, K/μL	193.74±75.33	187.62±77.27	0.13
HGB, g/L	140.75±17.07	136.79±17.39	0.02
RDW, %	13.35±0.86	13.18±0.88	0.01
AST, U/L	46.06±49.88	61.39±71.32	0.28
ALT, U/L	37.89±31.86	34.62±26.97	0.62
BUN, mmol/L	4.63±1.34	5.09±1.56	<0.01
Cre, umol/L	68.53±15.88	70.23±21.22	0.92
TC, mg/dL	3.85±0.97	3.78±0.86	0.63
TG, mg/dL	1.71±1.23	1.65±1.03	0.29
HDL-C, mg/dL	0.92±0.22	0.92±0.23	0.67
LDL-C, mg/dL	2.27±0.88	2.18±0.75	0.59
HbA1c, %	5.84±0.59	7.06±1.66	<0.01
hsCRP, mg/dL	2.31±2.32	2.74±2.55	0.21
CKMB, U/L	30.22±46.23	46.37±66.82	<0.01
Pro-BNP, pg/mL	942.10±2669.20	1330.19±2525.52	0.01
Medication at discharge
β-Blocker, %	197 (87.6)	200 (89.7)	0.48
ACEI/ARB, %	208 (92.4)	200 (89.7)	0.31
Statin, %	223 (99.1)	216 (96.9)	0.09
CCB, %	52 (23.1)	47 (21.1)	0.60
DAPT, %	224 (99.6)	220 (98.7)	0.31
ACS type
UA, %	173 (76.9)	143 (64.1)	0.01
NSTEMI, %	16 (7.1)	28 (12.6)
STEMI, %	36 (16.0)	52 (23.3)

Note: Data are presented as mean±SD or number (%).

Abbreviations: ACS, acute coronary syndrome; RDW, red cell distribution width; BMI, body mass index; MI, myocardial infarction; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; HR, heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure; WBC, white blood cell; RBC, red blood cell; PLT, platelet; HGB, hemoglobin; AST, aspartate aminotransferase; ALT, alanine aminotransferase; BUN, blood urea nitrogen; Cre, creatinine; TC, total cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; HbA1c, hemoglobin A1c; FBG, fasting blood glucose; hsCRP, high sensitivity C reactive protein; CKMB, creatine kinase isoenzyme; Pro-BNP, N-terminal pro-brain natriuretic peptide; ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; CCB, calcium channel antagonist; DAPT, dual antiplatelet therapy; UA, unstable angina; NSTEMI, non-ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction.

Figure 2 Kaplan–Meier survival curves for freedom from MACEs in the whole, low FBG and high FBG patient groups. Kaplan–Meier survival curves for freedom from MACEs in (A) The whole population by RDW level, (B) Low FBG by RDW level, and (C) High FBG by RDW level.

Abbreviations: MACEs, major cardiovascular adverse events; FBG, fasting blood glucose; RDW, red cell distribution width.

Table 4 Cox Multivariate Regression Analysis of MACEs in Whole Patients and ACS Patients with High FBG

Variable	Hazards Ratio	95% CI		P value
Whole
Low RDW
Medium RDW	3.28	1.79	5.99	<0.01
High RDW	2.15	1.10	4.17	0.02
BUN	1.19	1.03	1.39	0.02
CKMB	0.99	0.99	1.00	0.01
DAPT	0.11	0.01	0.83	0.03
Low FBG
Hypertension	2.26	1.19	4.29	0.01
BUN	1.37	1.12	1.67	<0.01
Pro-BNP	1.00	1.00	1.00	0.02
High FBG
Low RDW
Medium RDW	9.28	3.12	27.59	<0.01
High RDW	7.04	2.30	21.51	<0.01
Past PCI or CABG	0.59	0.37	0.94	0.03
DAPT	0.06	0.01	0.58	0.01

Abbreviations: MACEs, major cardiovascular adverse events; ACS, acute coronary syndrome; FBG, fasting blood glucose; CI, confidential interval; RDW, red cell distribution width; BUN, blood urea nitrogen; CKMB, creatine kinase isoenzyme; DAPT, dual antiplatelet therapy; Pro-BNP, N-terminal pro-brain natriuretic peptide; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting.

Figure 3 Receiver operating characteristic curve analysis of predictive value of RDW in (A) The whole, (B) Low FBG, and (C) High FBG patient groups.

Abbreviations: RDW, red cell distribution width; FBG, fasting blood glucose.