Insights into the Use of Erythrocyte and Platelet Distribution Indices for Assessing the Extent of Coronary Lesions

<i>Background/Objectives</i>: Red cell distribution width, platelet distribution width, and mean platelet volume are hematological indices derived from complete blood counts that have been increasingly investigated as potential cardiovascular biomarkers. This study aimed to assess the association between these indices and the extent of coronary artery disease, quantified by the Gensini score. <i>Methods</i>: We conducted a retrospective observational study of 240 patients hospitalized with typical angina who underwent elective coronary angiography at the Institute of Cardiovascular Diseases in Timișoara (January 2023-April 2024). Patients with hematological disorders, prior revascularization, or severe comorbidities were excluded. CAD severity was assessed by the Gensini score, with patients stratified into a low-score group (<50) and a high-score group (≥50). Laboratory and echocardiographic data were collected. Correlation analyses, ROC curve analysis, and multivariate regression were performed to evaluate predictors of CAD complexity. <i>Results</i>: Among 240 patients (81% male), 161 (67%) were in the high-score group. Compared with the low-score group, these patients had higher RDW (12.43 ± 0.68 vs. 12.70 ± 1.01, 95%CI: -0.52 to -0.02, <i>p</i> = 0.03), MPV (9.20 ± 0.88 vs. 9.45 ± 0.84, 95%CI: -0.48 to -0.02, <i>p</i> = 0.03), serum creatinine (<i>p</i> = 0.01), and potassium (<i>p</i> = 0.02), and lower ejection fraction (<i>p</i> < 0.001). RDW correlated positively with the Gensini score (rho = 0.28, 95%CI: 0.16-0.39, <i>p</i> = 0.001). Multivariate analysis identified RDW, MPV, and diastolic dysfunction as independent predictors. RDW showed weak discrimination for high Gensini burden (AUC = 0.57, 95% CI: 0.49-0.65, <i>p</i> > 0.05), consistent with a borderline, non-significant result. <i>Conclusions</i>: Elevated RDW and MPV are independently associated with greater coronary lesion burden. These routinely available indices may serve as novel, cost-effective markers for CAD risk stratification, warranting validation in prospective studies.