Prognostic value of red cell distribution width in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort studies
PubMed 42558361 · doi:10.3389/fcvm.2026.1787857
What was done
Systematic review and meta-analysis of literature indexed in PubMed, Embase, Web of Science, and the Cochrane Library through November 22, 2025. The authors evaluated the association between preprocedural red cell distribution width (RDW) and adverse clinical outcomes in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). Primary endpoints included all-cause mortality (ACM), cardiovascular mortality (CVM), and major adverse cardiovascular events (MACE), with in-stent restenosis assessed as an exploratory outcome. Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were quantitatively pooled where appropriate.
What was found
Twenty-four studies (31 comparison groups, ~83,000 patients) were included: - Elevated preprocedural RDW was significantly associated with higher ACM (HR 1.46, 95% CI 1.31–1.63). - Elevated RDW was significantly associated with higher CVM (HR 1.66, 95% CI 1.33–2.07). - Analysis of standard MACE showed an elevated risk (HR 1.24, 95% CI 1.06–1.45, p = 0.007), but this result was unstable in sensitivity analysis. - Only one study remained eligible for OR-based MACE analysis after endpoint reclassification, precluding quantitative synthesis.
Why it matters
Baseline RDW is an inexpensive, routine biomarker that provides prognostic information on mortality risk in patients undergoing PCI, though its link to composite ischemic endpoints is less robust.
Limits
The underlying primary studies were observational, preventing causal inference. Definitions of endpoints and cutoffs for elevated RDW were not standardized across the included cohorts, and the MACE association lacked stability in sensitivity testing.
Cited by
- supports Red cell distribution width (RDW) is an independent predictor of adverse clinical outcomes and mortality.