Prognostic value of red cell distribution width in patients undergoing percutaneous coronary intervention: a meta-analysis

Abstract

Objective: To evaluate the prognostic value of baseline red cell distribution width (RDW) in patients with coronary artery diseases (CADs) undergoing percutaneous coronary intervention (PCI) by conducting a meta-analysis.

Design: Systematic review and meta-analysis.

Data source: PubMed, Embase, Wanfang, CNKI and VIP databases were searched from their inceptions to 19 June 2019.

Eligible criteria: Studies investigating the value of baseline RDW for predicting all-cause mortality, cardiovascular mortality and major adverse cardiac events (MACEs) in patients with CAD undergoing PCI were included.

Data extraction and synthesis: Two authors independently extracted the data and evaluated the methodological quality using the Newcastle-Ottawa Scale. STATA V.12.0 software was applied to produce the forest plots using a random-effect model.

Results: Twelve studies (13 articles) involving 17 113 patients were included and analysed. Comparison between the highest and lowest RDW category indicated that the pooled risk ratio (RR) was 1.77 (95% CI 1.32 to 2.37) for all-cause mortality, 1.70 (95% CI 1.25 to 2.32) for cardiovascular mortality and 1.62 (95% CI 1.21 to 2.18) for MACEs. The predictive effect of elevated RDW for all-cause mortality was stronger in the subgroup of patients without anaemia (RR 4.59; 95% CI 3.07 to 6.86) than with anaemia.

Conclusions: This meta-analysis indicated that elevated RDW was associated with higher risk of mortality and adverse cardiac events in patients with CAD undergoing PCI. The value of elevated RDW for predicting all-cause mortality appears to be stronger in patients without anaemia. RDW may be served as a promising prognostic biomarker in patients undergoing PCI.

Keywords: all-cause mortality; major adverse cardiac events; meta-analysis; percutaneous coronary intervention; red cell distribution width.

Figure 1

Flow chart of studies’ selection process.

Figure 2

Forest plots showing pooled risk ratio with 95% CI of all-cause mortality for the higher versus lower red cell distribution width group in overall (A) and without anaemia (B) patients.

Figure 3

Forest plots showing pooled risk ratio with 95% CI of cardiovascular mortality for the higher versus lower red cell distribution width group in overall patients.

Figure 4

Forest plots showing pooled risk ratio with 95% CI of major adverse cardiac events for the higher versus lower red cell distribution width group in overall patients.