Document Detail


Clinical usefulness of measuring red blood cell distribution width on admission in patients with acute coronary syndromes.
MedLine Citation:
PMID:  19676148     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Conventional cardiac markers used for the biochemical diagnosis of acute coronary syndromes (ACS) have a high specificity but low sensitivity within 2-4 h of symptoms onset. The red blood cell distribution width (RDW), reflecting the size variability of circulating red blood cells, has been shown to be independently associated with an increased risk of major cardiovascular events. We assessed whether there is an association between RDW at admission and cardiac troponin T (cTnT) elevation in patients with chest pain. METHODS: We analyzed RDW values in 2304 adult patients, who were consecutively admitted over a 1-year period to the local emergency department for chest pain suggestive of ACS. In all patients, a baseline blood sample was collected for routine haematological testing, whereas cTnT was measured at baseline and after 4, 6, and 12 h. RESULTS: A total of 456 patients (19.8% of total) had ACS. These patients, all having cTnT> or =0.03 microg/L up to 12 h from admission other than ischaemic electrocardiographic changes, had higher RDW than non-ACS patients [median 15.1%, (5th-95th percentiles) 13.2%-19.0% vs. 13.5%, 12.9%-17.1%, p<0.001]. On admission, the sensitivity and specificity of cTnT were 94% (25 false negative results) and 100%, respectively. The diagnostic accuracy of RDW, as calculated by the receiver operating characteristic curve analysis, was 0.705 (p<0.001). At the cut-off value of 14%, the clinical sensitivity and specificity of RDW on admission were 79% and 50%, respectively. In 21 out of 25 patients classified as false negative for cTnT on admission, the RDW was >14%. Accordingly, the diagnostic sensitivity of the two combined measurements on admission was 99%. CONCLUSIONS: As RDW is widely available to clinicians as a part of the complete blood count, and therefore incurs no additional costs, it might be considered with other conventional cardiac markers for the risk stratification of ACS patients admitted to emergency departments.
Authors:
Giuseppe Lippi; Luca Filippozzi; Martina Montagnana; Gian Luca Salvagno; Massimo Franchini; Gian Cesare Guidi; Giovanni Targher
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical chemistry and laboratory medicine : CCLM / FESCC     Volume:  47     ISSN:  1434-6621     ISO Abbreviation:  Clin. Chem. Lab. Med.     Publication Date:  2009  
Date Detail:
Created Date:  2009-08-13     Completed Date:  2009-08-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9806306     Medline TA:  Clin Chem Lab Med     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  353-7     Citation Subset:  IM    
Affiliation:
Sezione di Chimica Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Ospedale Policlinico G.B. Rossi, Verona, Italy. ulippi@tin.it
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / blood*,  diagnosis
Adult
Aged
Aged, 80 and over
Biological Markers / blood
Erythrocyte Indices*
Female
Humans
Male
Middle Aged
ROC Curve
Sensitivity and Specificity
Chemical
Reg. No./Substance:
0/Biological Markers

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