Iranian Heart Journal

Iranian Heart Journal

Red Cell Distribution Width (RDW) as a Prognostic Index in Acute Coronary Syndrome

Document Type : Original Article

Authors
Hakimeh Saadatifar 1
Saber Rostami 2
Maryam Khorramizadeh 3
Zahra Eslamifar 4
1 Department of Cardiology, School of Medicine, Dezful University of Medical Sciences, Dezful, IR Iran.
2 Student Research Committee, Dezful University of Medical Sciences, Dezful, IR Iran.
3 Department of Medical Physics, School of Paramedicine, Dezful University of Medical Sciences, Dezful, IR Iran.
4 Department of Medical Laboratory Sciences, School of Paramedical Sciences, Dezful University of Medical Sciences, Dezful, IR Iran.
Abstract
Background: Acute coronary syndrome is a leading cause of mortality in cardiovascular disease. Red blood cell distribution width (RDW), a component of the complete blood count, has been associated with various clinical outcomes. This study investigated the relationship between RDW and in-hospital prognosis in patients with ACS.
 
Methods: We included 628 consecutive patients admitted with ACS. The RDW level at admission and the following prognostic factors were extracted and recorded: in-hospital mortality, presence of malignant ventricular arrhythmia, reduction in left ventricular ejection fraction, number of major cardiovascular risk factors, presence of diabetes mellitus, duration of hospitalization, number of significantly diseased coronary vessels, type of coronary intervention (percutaneous coronary intervention, coronary artery bypass grafting, or medical follow-up), and troponin positivity (indicative of myocardial infarction). The relationship between RDW level and these parameters was analyzed.
 
Results: Patients were stratified into two groups based on baseline RDW level: an RDW of 14.0% or greater and an RDW of less than 14.0%. The mortality rate was significantly higher in the high-RDW group than in the normal-RDW group. Mean age, incidence of malignant ventricular arrhythmia, number of cardiovascular risk factors, and length of hospitalization were also significantly greater in patients with high RDW.
 
Conclusions: An elevated RDW at admission in patients with ACS is a noninvasive, readily available test that may aid in prognostic assessment and stratifying in-hospital mortality risk. This parameter may warrant consideration in future clinical guidelines. (Iranian Heart Journal 2026; 27(1): 6-16)
Keywords
acute coronary syndrome (ACS)
red cell distribution width (RDW)
in-hospital prognosis
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Iranian Heart Journal
Volume 27, Issue 1
Winter 2026
Pages 6-16