Correlation between red blood cell distribution width and in-stent restenosis after percutaneous coronary intervention in patients with coronary heart disease after PCI

Objective To investigate the correlation between red blood cell distribution width (RDW) and in-stent restenosis (ISR) in patients with coronary heart disease after PCI. Methods A total of nine hundred and seventy-eight patients with coronary heart disease treated in Beijing Anzhen Hospital, Capital Medical University with DES stent implantation from March 2015 to March 2016 were enrolled in the study.Among them, 493 patients (50.41%) underwent coronary angiography in the hospital at 6-12 months after the operation.According to the results of the angiography, the patients were divided into two groups: the ISR group and the non-ISR group.The basic data of the patients, the laboratory indexes and the coronary interventional procedures record were collected to analyze the factors that could lead to in-stent restenosis. Results 51 cases (10.34%) in the ISR group and 442 cases (89.66%)in the non-ISR group.The baseline characteristics of the two groups were similar, and there was no significant difference in gender, age, body mass index, combined with hypertension, family history of coronary heart disease, long-term administration of statin and follow-up interval (P>0.05). The proportion of patients with diabetes was significantly higher than that of the non-ISR group(37.3% vs.22.6%, P=0.021); the smoking rate was significantly higher in the ISR group (52.9% vs.35.7%, P=0.016). In terms of laboratory examination, there were no significant differences between the two groups in blood lipid levels and WBC, RBC, Hb and PLT counts between the two groups (P>0.05). The levels of serum RDW(13.4(13.00, 13.80) vs.12.7(12.40, 13.10), P<0.01) and hs-CRP (3.15(2.32, 4.63) vs.1.33(0.63, 3.16), P<0.01) were significantly increased in the patients with ISR.The stent length was longer in the ISR group((21.87±5.20)mm vs.(19.14±4.87)mm, P<0.01), the stent diameter was smaller ((2.87±0.38)mm vs.(3.09±0.36)mm, P<0.01), the number of cases with serial stents in ISR group was higher than that in non-ISR group(45.1 % Vs 30.8%, P=0.038). Multivariate logistic regression analysis showed that RDW (OR=2.396, 95%CI 1.655-3.471; P<0.01), hs-CRP (OR=1.052, 95%CI: 1.001-1.105; P=0.044), DM (OR=2.029, 95%CI : 1.004-4.100; P=0.049), smoking (OR=2.252, 95%CI: 1.060-4.783; P=0.035), stent length (OR=1.149, 95%CI: 1.072-1.230; P<0.01), stent diameter(OR=0.210, 95%CI: 0.079-0.558; P=0.002)and serial stents(OR=2.306, 95%CI: 1.162-4.575; P=0.017) were independent risk factors for in-stent restenosis. Conclusion Red blood cell distribution width is an independent predictor of in-stent restenosis after PCI in patients with coronary heart disease.Chronic inflammation and oxidative stress may be the most important pathogenesis of ISR. Key words: Red Blood Cell Distribution Width; Coronary Heart Disease; Percutaneous Coronary Intervention; In-stent Restenosis