title: Red cell distribution width and additive risk prediction for major bleeding in non-ST-segment elevation acute coronary syndrome.
abstract: OBJECTIVE
  Red cell distribution width has been linked to an increased risk for in-hospital bleeding in patients with non-ST-segment elevation acute coronary syndrome. However, its usefulness for predicting bleeding complications beyond the hospitalization period remains unknown. Our aim was to evaluate the complementary value of red cell distribution width and the CRUSADE scale to predict long-term bleeding risk in these patients.
  
  
  METHODS
  Red cell distribution width was measured at admission in 293 patients with non-ST-segment elevation acute coronary syndrome. All patients were clinically followed up and major bleeding events were recorded (defined according to Bleeding Academic Research Consortium Definition criteria).
  
  
  RESULTS
  During a follow-up of 782 days [interquartile range, 510-1112 days], events occurred in 30 (10.2%) patients. Quartile analyses showed an abrupt increase in major bleedings at the fourth red cell distribution width quartile (> 14.9%; P=.001). After multivariate adjustment, red cell distribution width >14.9% was associated with higher risk of events (hazard ratio=2.67; 95% confidence interval, 1.17-6.10; P=.02). Patients with values ≤ 14.9% and a CRUSADE score ≤ 40 had the lowest events rate, while patients with values >14.9% and a CRUSADE score >40 points (high and very high risk) had the highest rate of bleeding (log rank test, P<.001). Further, the addition of red cell distribution width to the CRUSADE score for the prediction of major bleeding had a significant integrated discrimination improvement of 5.2% (P<.001) and a net reclassification improvement of 10% (P=.001).
  
  
  CONCLUSIONS
  In non-ST-segment elevation acute coronary syndrome patients, elevated red cell distribution width is predictive of increased major bleeding risk and provides additional information to the CRUSADE scale.
authors.affiliation: Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: Marianela
authors.initials: M
authors.lastname: Sánchez-Martínez
authors.affiliation: Departamento de Medicina Interna, Hospital de la Vega Lorenzo Guirao, Cieza, Murcia, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: López-Cuenca
authors.affiliation: Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Marín
authors.affiliation: Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Flores-Blanco
authors.affiliation: Departamento de Bioquímica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: García Narbon
authors.affiliation: Departamento de Bioquímica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: de las Heras-Gómez
authors.affiliation: Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Sánchez-Galian
authors.affiliation: Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés-Chávarri
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States.
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.affiliation: Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain. Electronic address: sergiosmf13@hotmail.com.
authors.forename: Sergio
authors.initials: S
authors.lastname: Manzano-Fernández
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications*; D000368:Aged; D004909:Erythrocyte Indices / Q000502:physiology; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000209:etiology*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications; D011446:Prospective Studies; D012307:Risk Factors
keywords: Acute coronary syndrome; Ancho de distribución eritrocitaria; Bleeding; Hemorragia; Red cell distribution width; Síndrome coronario agudo