R/S ratio in lead II, and the prognostic significance of red cell distribution width in acute coronary syndrome

doi:10.12998/wjcc.v7.i16.2217

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World J Clin Cases. Aug 26, 2019; 7(16): 2217-2226
Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2217

Table 1 Baseline characteristics of acute coronary syndrome study patients

	All patients	Patients with		z	P-value
	All patients	RSR > 1	RSR < 1	z	P-value
Baseline characteristics
Age, mean ± SD, yr	61.56 ± 9.42	60.9 ± 11.36	62.22 ± 10.40	-0.706	0.001
Sex, Male/Female	830/466	255/109	575/357		0.002
Laboratory finding
TG, mg/dL	141.69 ± 81.30	139.30 ± 75.97	143.71 ± 85.52	-0.195	0.232
CHOL, mg/dL	173.71 ± 72.40	173.00 ± 70.72	174.30 ± 74.18	-0.156	0.286
HDL, mg/dL	34.44 ± 9.13	34.14 ± 9.23	34.44 ± 9.14	-0.057	0.398
LDL, mg/dL	108.75 ± 50.88	108.97 ± 50.91	108.56 ± 50.87	-0.404	0.065
LVEF, %	52.29 ± 14.27	41.17 ± 10.41	54.30 ± 11.48	-6.704	0.001
GS	37.88 ± 36.7	48.39 ± 36.44	29.74 ± 37.56	-7.549	0.001
cTn 1, ng/mL	1.86 ± 3.92	1.19 ± 1.84	0.42 ± 0.81	-7.148	0.001
cTn 2	5.02 ± 4.61	5.92 ± 6.12	2.43 ± 3.81	-8.101	0.001
cTn 3	11.81 ± 12.31	9.49 ± 12.74	4.57 ± 7.72	-7.361	0.001
BS, mg/dL	137.31 ± 60.49	136.94 ± 64.19	135.02 ± 63.44	-0.718	0.526
WBC, 10³/μL	10.17 ± 3.31	9.89 ± 3.25	10.64 ± 3.82	-0.382	0.247
MCV, fL	88.23 ± 7.32	88.92 ± 7.42	88.48 ± 7.60	-0.249	0.642
MCH, pg	29.31 ± 2.31	29.43 ± 2.41	29.62 ± 2.38	-0.262	0.342
MCHC, g/dL	32.92 ± 0.81	32.96 ± 0.79	32.63 ± 0.72	-0.593	0.329
RDW, %	14.48 ± 2.12	15.42 ± 1.82	14.92 ± 2.48	-7.254	0.001
MPV, fL	8.53 ± 1.36	10.48 ± 3.47	8.96 ± 2.24	-2.823	0.019
Neu, %	6.25 ± 3.56	7.42 ± 1.44	6.82 ± 2.31	-14.762	0.001
Lymph, %	2.13 ± 1.12	2.32 ± 1.21	2.02 ± 1.19	-0.667	0.422

TG: Triglycerides; CHOL: Cholesterol; HDL: High density lipoprotein; LDL: Low density lipoprotein; RSR: R to S ratio; LVEF: Left ventricular ejection fraction; GS: Gensini score; cTn: Troponin; BS: Blood sugar; WBC: White blood cell; MCV; Mean corpuscular volume; MCH: Mean corpuscular haemoglobin; MCHC: Mean corpuscular haemoglobin concentration; RDW: Red cell distribution width; MPV: Mean platelet volume; Neu: Neutrophil; Lymph: Lymphocyte. P < 0.05.

Table 2 χ² analysis of acute coronary syndrome according to R to S ratio variables

		Patients with		χ²	P-value
		RSR > 1, n (%)	RSR < 1, n (%)	χ²	P-value
Sex, Male/Female		255/109 (19.7/8.4)	575/357 (44.4/27.5)	6.6	0.001
Diagnosis	UA	78 ( 6.9)	424 (32.7)	284.12	0.001
	AIMI	184 (14.2)	65 (5.0)
	AAMI	61 (4.7)	263 (20.3)
	NSTEMI	40 (3.1)	180 (13.9)
Complication	No	114 (8.9)	524 (40.5)	89.23	0.001
	IHF	151 (11.7)	251 (19.4)
	VT	16 (1.2)	66 (5.1)
	AV Block	43 (3.1)	21 (1.7)
	PE/CT	9 (0.7)	18 (1.3)
	APE	37 (2.5)	46 (3.9)
Tree-vessel Disease	No	253 (19.6)	733 (56.5)	10.03	0.001
Tree-vessel Disease	Yes	111 (8.5)	199 (15.3)
Mortality	No	292 (22.5)	845 (65.2)	24.39	0.001
Mortality	Yes	72 (5.6)	87 (6.7)

UA: Unstable angina; AIMI: Acute inferior myocardial infarction; AAMI: Acute anterior myocardial infarction; NSTEMI: Non-ST elevation MI; IHF: Ischemic heart failure; VT: Ventricular tachycardia; AV: Atrioventricular; PE: Pericardial effusion; CT: Cardiac tamponade; APE: Acute pulmonary oedema. P < 0.05.

Table 3 χ² analysis of acute coronary syndrome according to diagnostic variables

Diagnosis		UA, n (%)	AIMI, n (%)	AAMI, n (%)	NSTEMI, n (%)	χ²	P-value
Complication	No	388 (29.8)	102 (7.8)	76 (5.9)	74 (5.7)	384.01	0.001
	IHF	72 (5.5)	76 (5.9)	176 (13.6)	78 (6.0)
	VT	11 (0.8)	8 (0.6)	41 (3.2)	22 (1.7)
	AV Block	9 (0.7)	47 (3.6)	4 (0.3)	4 (0.3)
	PE/CT	9 (0.7)	5 (0.4)	6 (0.5)	7 (0.5)
	APE	14 (1.1)	12 (0.9)	45 (3.5)	12 (0.9)
TVD	No	497 (38.3)	193 (14.9)	156 (12.9)	139 (10.7)	293.61	0.001
TVD	Yes	5 (0.4)	56 (4.3)	192 (14.8)	58 (4.4)
Mortality	No	485 (37.4)	207 (16)	280 (21.6)	165 (12.7)	56.73	0.001
Mortality	Yes	17 (1.3)	42 (3.2)	68 (5.2)	32 (2.5)

Table 4 χ² analysis of acute coronary syndrome according to blocked major coronary artery variables

	Complication						TVD		Mortality
	No, n (%)	IHF, n (%)	VT, n (%)	AV Block, n (%)	PE/CT, n (%)	APE, n (%)	No, n (%)	Yes, n (%)	No, n (%)	Yes, n (%)
RCA	128 (9.8)	74 (5.7)	11 (0.8)	24 (1.8)	6 (0.4)	5 (0.4)	165 (12.7)	184 (14.2)	243 (20)	37 (2.8)
R1	23 (1.8)	8 (0.7)	0 (0)	6 (0.4)	0 (0)	1 (0.1)	26 (2)	47 (3.6)	26 (2)	4 (0.3)
R2	32 (2.5)	12 (0.9)	0 (0)	3 (0.2)	1 (0.1)	0 (0)	32 (2.5)	45 (3.4)	36 (2.7)	1 (0.1)
R3	34 (2.6)	15 (1.1)	1 (0.1)	4 (0.3)	0 (0)	1 (0.1)	46 (3.5)	23 (1.8)	45 (3.5)	4 (0.3)
R4	18 (1.4)	11 (0.8)	0 (0)	1 (0.1)	1 (0.1)	5 (0.4)	29 (2.2)	11 (0.8)	33 (2.5)	7 (0.5)
L	74 (5.7)	6 (0.4)	14 (1)	9 (0.8)	4 (0.3)	5 (0.4)	81 (6.2)	47 (3.6)	75 (5.7)	17 (1.3)
L1	78 (6.2)	127 (9.8)	18 (6)	5 (0.4)	5 (0.4)	23 (1.8)	93 (7.1)	169 (13)	192 (14.8)	31 (2.4)
L2	133 (10.3)	119 (9.1)	16 (1.2)	7 (0.5)	7 (0.6)	19 (1.5)	181 (14)	94 (7.2)	269 (20.7)	43 (3.3)
L1A	37 (2.8)	4 (0.3)	13 (1)	1 (0.1)	0 (0)	12 (0.9)	163 (12.3)	7 (0.6)	53 (4.1)	7 (0.5)
L1B	23 (1.8)	8 (0.7)	4 (0.3)	2 (0.1)	0 (0)	4 (0.3)	42 (2.1)	4 (0.3)	37 (2.8)	1 (0.1)
L1C	12 (0.9)	2 (0.1)	5 (0.4)	1 (0.1)	0 (0)	2 (0.1)	27 (2)	4 (0.3)	23 (1.8 )	4 (0.3)
L2A	43 (3.3)	9 (0.8)	2 (0.1)	0 (0)	2 (0.1)	5 (0.4)	61 (4.7)	6 (0.5)	58 (4.5)	9 (0.8)
L2B	22 (1.7)	4 (0.3)	1 (0.1)	0 (0)	1 (0.1)	1 (0.1)	30 (2.3)	6 (0.5)	32 (2.5)	0 (0)
L2C	8 (0.6)	3 (0.2)	1 (0.1)	1 (0.1)	0 (0)	0 (0)	14 (11.)	2 (0.1)	15 (1.1)	1 (0.1)
χ²	1631.09						102.32		19.51
P-value	0.001						0.001		0.001

TVD: Tree-vessel disease; RCA: Right coronary artery; R1: Proximal RCA; R2: Mid RCA; R3: Distal RCA; R4: Posterior descending artery; L: Left coronary artery; L1: Circumflex artery; L2: Left anterior descending artery; L1A: Marginal artery; L1B: Posterior descending artery; L1C: Posterior lateral branch; L2A: 1^st diagonal artery; L2B: 2^nd diagonal artery; L2C: Distal left anterior descending artery.

Table 5 Univariate and multivariate Cox regression analyses for predicting the development of R to S ratio

	Univariate			Multivariate			Correlation
	HR	95%CI	P-value	HR	95%CI	P-value	r	P-value
LVEF	0.964	0.919-0.933	0.001	0.945	0.896-0.410	0.001	-0.431	0.001
Mortality	3.924	2.748-5.708	0.001	1.463	0.989-2.219	0.004	0.242	0.001
TVD	2.197	1.592-2.911	0.001	3.471	1.419-7.133	0.001	0.189	0.001
cTn I	1.992	1.592-2.911	0.001	1.983	1.398-2.789	0.001	0.372	0.001
cTn II	1.145	1.117-1.189	0.001	1.278	1.233-1.491	0.001	0.326	0.001
cTn III	1.161	1.146-1.275	0.001	0.898	0.889-0.979	0.001	0.258	0.001
RDW	0.991	0.925-1.146	0.002	0.892	0.797-0.919	0.001	0.267	0.001
GS	1.109	1.102-1.114	0.001	0.996	0.986-1.005	0.386	0.208	0.001
Complication	1.368	1.322-1.469	0.001	0.993	0.989-1.178	0.752	0.267	0.001
Age	1.015	0.996-1.019	0.432	1.031	0.984-1.029	0.842	0.062	0.022
Gender	1.078	0.799-1.382	0.761	0.847	0.552-1.284	0.419	0.019	0.017

Multiple Cox proportional hazards model includes all the variables in univariate analysis with forward stepwise method. CI: Confidence interval; HR: Hazard ratio; LVEF: Left ventricular ejection fraction; TVD: Tree-vessel disease; RDW: Red cell distribution width; GS: Gensini score.

Citation: Coşkun A, Eren SH. R/S ratio in lead II, and the prognostic significance of red cell distribution width in acute coronary syndrome. World J Clin Cases 2019; 7(16): 2217-2226
URL: https://www.wjgnet.com/2307-8960/full/v7/i16/2217.htm
DOI: https://dx.doi.org/10.12998/wjcc.v7.i16.2217