Key result
Addition of hematological parameters, notably red cell distribution width, significantly improved prediction of MACE (HR 1.19; 95% CI 1.08-1.32; P<0.001 per 1 SD increase).
Why the study?
Prediction of secondary cardiovascular events after initial coronary artery disease events remains a challenge beyond established primary event risk scores.
Does the addition of routinely measured hematological parameters improve the prediction of mortality and secondary adverse events in coronary angiography patients compared to traditional risk factors alone?
Cohort (n=1,760)
Does the addition of routinely measured hematological parameters improve the prediction of mortality and secondary adverse events in coronary angiography patients compared to traditional risk factors alone?
Routinely measured hematological parameters, particularly red cell distribution width, significantly improve the prediction of mortality and secondary adverse events in patients undergoing coronary angiography.
Answers are grounded in this paper and cite their sources.
May enhance MACE prediction in angiography patients; hypothesis-generating and requires prospective validation before practice change.
Prediction of primary cardiovascular events has been thoroughly investigated since the landmark Framingham risk score was introduced. However, prediction of secondary events after initial events of coronary artery disease (CAD) poses a new challenge. In a cohort of coronary angiography patients (n = 1760), we examined readily available hematological parameters from the UPOD (Utrecht Patient Oriented Database) and their addition to prediction of secondary cardiovascular events. Backward stepwise multivariable Cox regression analysis was used to test their ability to predict death and major adverse cardiovascular events (MACE). Continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) measures were calculated for the hematological parameters on top of traditional risk factors to assess prediction improvement. Panels of 3 to 8 hematological parameters significantly improved prediction of death and adverse events. The IDIs ranged from 0.02 to 0.07 (all P < 0.001) among outcome measures and the cNRIs from 0.11 to 0.40 (P < 0.001 in 5 of 6 outcome measures). In the hematological panels red cell distribution width (RDW) appeared most often. The multivariable adjusted hazard ratio of RDW per 1 standard deviation (SD) increase for MACE was 1.19 [1.08-1.32], P < 0.001. Routinely measured hematological parameters significantly improved prediction of mortality and adverse events in coronary angiography patients. Accurately indicating high-risk patients is of paramount importance in clinical decision-making.
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Gijsberts et al. (2015) conducted a cohort in Coronary artery disease (n=1,760). Hematological parameters (including red cell distribution width) vs. Traditional risk factors was evaluated on Death and major adverse cardiovascular events (MACE) (HR 1.19, 95% CI 1.08-1.32, p=<0.001). Addition of hematological parameters, notably red cell distribution width, significantly improved prediction of MACE (HR 1.19; 95% CI 1.08-1.32; P<0.001 per 1 SD increase).
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