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Background  In-stent restenosis remains an unresolved issue. Inflammation plays a pivotal role in the process of in - stent restenosis. Significant and positive associations were found between red blood cell distribution width (RDW) and inflammation. But whether there is a close relationship between higher RDW and in - stent restenosis is still not clarified.    Methods  This retrospective observational study investigated 214 consecutive patients with unstable angina pectoris who underwent successful percutaneous coronary interventions with drug-eluting stents. Patients were divided into three groups according to baseline RDW before percutaneous coronary interventions (low RDW group:≤12.5%; intermediate RDW group:> 12.5% and ≤ 13.5%; high RDW group:> 13.5%). The follow-up angiographies were routinely performed 9–12 months after the initial percutaneous coronary interventions. The multivariate logistic regression analysis was employed to determine the independent predictors of in - stent restenosis.    Results  The in - stent restenosis rate was significantly higher in group with higher baseline RDW value (12.3, 19.7, 47.7% in low, intermediate, and high RDW groups respectively,  P  < 0.001). The baseline RDWs were significantly higher in patients with in - stent restenosis compared with those in patients without in - stent restenosis (13.7 ± 0.8% vs. 13.0 ± 0.8%,  P  < 0.001). For prediction of in - stent restenosis, the ROC (receiver operating characteristic) curve analysis demonstrated the optimal RDW cutoff value was 13.37 (sensitivity: 65.5%, specificity: 73.6%); the diagnosis cutoff value was 13.89 (sensitivity: 40.0%, specificity: 91.8%); the screening cutoff value was 12.99 (sensitivity: 83.6%, specificity: 49.1%). By multivariate logistic analysis, higher baseline RDW (odds ratio [OR], 5.179; 95% confidence interval [CI], 2.568 to 10.446;  P   <  0.001) together with lower baseline indirect bilirubin (OR, 0.413; 95% CI, 0.305 to 0.559;  P   <  0.001) and diabetes (OR, 4.077; 95% CI, 1.654 to 10.054;  P    =   0.002) were closely associated with in - stent restenosis at followup (11.1 ± 5.8 months).    Conclusions  The baseline RDW was closely associated with in - stent restenosis at follow-up. The patients with higher baseline RDW might have more chances to develop in - stent restenosis at followup.

High red blood cell distribution width is closely associated with in-stent restenosis in patients with unstable angina pectoris