A Study of Haematological Indices and Their Correlation With in-Hospital Mortality & Morbidity in Acute Coronary Syndrome

Abstract

Background: Coronary Artery Disease (CAD), an emerging pandemic is causing significant morbidities and mortalities across the globe. ACS is a life threatening manifestation of CAD. It warrants an early risk stratification and timely intervention. Prompt Clinical Evaluation, ECG and Biomarkers remain corner stone in approaching ACS. Recently, Haematological indices, have gained attention because of their significant associations in predicting outcomes of CAD. We carried out a prospective cross-sectional study among ACS patients to find the association of Red Cell Distribution Width (RDW), Haemoglobin Corrected RDW (HbCRDW), Red Cell Width Volume Index (RWVI), Neutrophil/Lymphocyte Ratio (NLR) and Platelet Distribution Width (PDW) with in-hospital Major Adverse Cardiac Events (MACEs) such as Recurrent Angina, Clinical LVF, LV Dysfunction by ECHO, Arrhythmias and Death.Methods: A total of 100 patients diagnosed to have ACS (Unstable Angina, STEMI, NSTEMI) and admitted in our hospital were enrolled for the study. The significance of association between the haematological parameters of interest with the MACEs were found using Fisher Exact Test. Results: The mean age of study participants was 55.72±11.07 years with 74% of them being males. 36% were Diabetic, 41% were hypertensive and 19% had both as major CAD risk factors. The distribution of ACS was a majority 68% with STEMI, 21% with Unstable Angina and 11% with NSTEMI. 81 of them underwent Coronary Angiogram and subsequently 49 patients had revascularisation procedure within their in-hospital stay. Frequency of occurrence of In-hospital MACEs were 17% Recurrent Angina, 42% Clinical LVF, 57% LV Dysfunction (mild-25%; moderate-21%; severe-11%), 18% Arrhythmias and 10% Mortality. Using Fisher-Exact test, RDW (>15%) had a significant association with Recurrent Angina (P=0.012) and LV Dysfunction (P=0.09). Higher tertiles of HbCRDW & RWVI had significance in predicting Recurrent Angina with P values of 0.013&0.043 respectively. Higher tertiles of NLR (>3.75) was statistically significant in prediction of Clinical LVF (P=0.086) and Arrhythmias (P=0.080). None of the studied parameters were found to have significance in predicting in-hospital mortality.Conclusion: RDW and its derived indices HbCRDW, RWVI are strong predictors of in-hospital Recurrent Angina among ACS patients. In addition, Higher values of RDW are also useful in predicting LV dysfunction. Though, there was no significant relationship between PDW and MACEs, NLR is found significant in predicting clinical LV failure and arrhythmias.