Correlation of red cell distribution width with the severity of coronary artery disease on coronary angiography as assessed by modified Gensini score in acute coronary syndrome patients

Abstract

Background: Coronary artery disease (CAD) remains a leading cause of global mortality, with Indian populations experiencing earlier onset and higher death rates. While traditional biomarkers aid diagnosis, their limitations in early detection necessitate alternative indicators. Red cell distribution width (RDW), an inexpensive and routinely measured hematological parameter, has emerged as a potential marker for cardiovascular risk stratification. Objectives were to evaluate the association of RDW with the severity of CAD assessed via the modified Gensini score (MGS) in patients presenting with acute coronary syndrome (ACS).

Methods: This cross-sectional observational study enrolled 500 consecutive patients presenting with ACS at a tertiary care center in Jaipur, India, between November 2018 and April 2020. All participants underwent diagnostic coronary angiography (CAG). CAD severity was quantified using the MGS mild: ≤80 and severe: >80. Complete blood count parameters, including RDW-CV and RDW-SD, were measured and analyzed across subgroups defined by disease severity, number of diseased vessels, myocardial infarction subtype, and in-hospital outcomes.

Results: Elevated RDW-CV (>13.7%) was significantly associated with severe CAD (p=0.009). Patients with higher RDW-CV had significantly higher Gensini scores (mean: 13.76±0.53% vs. 13.65±0.39%, p=0.048). However, no statistically significant associations were observed between RDW-CV or RDW-SD and the number of diseased vessels (p>0.05), infarction subtypes (p>0.05), or in-hospital mortality (p>0.05). Receiver operating characteristic (ROC) analysis demonstrated that an RDW-CV cutoff of >13.7% predicted severe CAD with an area under the curve (AUC) of 0.651 (95% CI: 0.549-0.744; sensitivity: 68.7%, specificity: 64.7%).

Conclusions: Elevated RDW-CV correlates significantly with angiographic severity of CAD in patients presenting with ACS. However, its capacity to discriminate multi-vessel involvement or acute in-hospital mortality remains limited.