title: Red blood cell distribution width predicts long term cardiovascular event after on-pump beating coronary artery bypass grafting.
abstract: BACKGROUND
  Reports investigating the predictive value of red cell distribution width (RDW) on major cardiac and cardiovascular event (MACCE) following coronary artery bypass grafting (CABG) have major limitations, including lack of elimination of common factors affecting RDW levels, such as anemia. The purpose of this study is to identify the real effect of higher RDW level, free from the other factors, on MACCE following CABG.
  
  
  METHODS
  Data of 500 consecutive, non-anemic patients (77.2 % male and mean age 63.05 ± 9.24) undergoing ONBHCAB between January 2007 and January 2010, were analyzed retrospectively.
  
  
  RESULTS
  Overall MACCE was 7.8 % of all cases. Mean follow-up was 66.5 ± 9.96 months. In multivariate Cox regression analysis, RDW (P = 0.022) remained the only independent predictor of MACCE and the ROC analyze revealed an RDW cut-off value of 13.95 % predicting MACCE. Therefore, patients were grouped on this cut-off value. There were 238 patients in the lower RDW group (Group 1) and 262 patients in the higher RDW group (Group 2). Kaplan-Meier survival analysis of freedom from MACCE revealed significantly lower event free survival in Group 2 (P < 0.001 by the log-rank test). Group 2 showed a higher MACCE incidence in 1 year (P = 0.030), in 3 years (P < 0.001) and in 6 years (P < 0.001). The long-term follow-up was similar regarding noncardiovascular mortality.
  
  
  CONCLUSIONS
  An RDW level greater than 13.95 % in hospital admission is independently associated with an increased incidence of MACCE after CABG. Physicians should be more aggressive in the management of these patients.
authors.affiliation: Department of Cardiovascular Surgery, Balikesir University, School of Medicine, 10010, Balikesir, Turkey. gurbuzorcun@gmail.com.
authors.forename: Orcun
authors.initials: O
authors.lastname: Gurbuz
authors.affiliation: Department of Cardiovascular Surgery, Balikesir University, School of Medicine, 10010, Balikesir, Turkey.
authors.forename: Gencehan
authors.initials: G
authors.lastname: Kumtepe
authors.affiliation: Department Of Cardiology, Bahcesehir University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Ozkan
authors.affiliation: Department of Cardiovascular Surgery, Samsun Hospital for Education and Research, Ilkadim, 55090, Samsun, Turkey.
authors.forename: Ilker Hasan
authors.initials: IH
authors.lastname: Karal
authors.affiliation: Department of Cardiovascular Surgery, Balikesir University, School of Medicine, 10010, Balikesir, Turkey.
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Ercan
authors.affiliation: Department of Cardiovascular Surgery, Acıbadem Bursa Hospital, Bursa, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Ener
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000097:blood* / Q000453:epidemiology / Q000601:surgery*; D004909:Erythrocyte Indices; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies
keywords: Coronary artery bypass grafting; Major cardiovascular event; Red cell distribution width