## 4 Discussion  
The present study revealed MCV, RDW, MPV, and PDW as important predictors of prognosis in individuals with NSTEMI. In the multivariate logistic regression analysis, there was a relevant relationship between MCV, in-hospital death, and Killip class III/IV, as well as between MPV, Killip class III/IV, and kidney dysfunction. Furthermore, RDW showed a positive association with kidney dysfunction, a longer duration of hospitalization, triple vessel disease, and an increased risk of the patient requiring surgical revascularization. Additionally, our study demonstrated a positive linear regression between PDW and 30-day mortality. Excluding individuals at an extremely high risk requiring angiography within 2 h, the latest guidelines for NSTEMI suggest coronary angiography with the aim of conducting revascularization within 24 h of hospital admission [14]. Limited research exists regarding the comparison between immediate invasive interventions and delayed angiography. The randomized RIDDLE NSTEMI study (randomized study of immediate vs. delayed invasive intervention in patients with non-ST-segment elevation myocardial infarction) showed that an immediate invasive strategy (<2 h) improves cardiovascular outcomes compared to a delayed strategy (2 to 72 h) [16]. Additionally, the clinical trial EARLY (early or delayed revascularization for intermediate and high-risk non-ST-elevation acute coronary syndrome) showcased a decline in cardiovascular death and recurrent ischemic events at 1 month in very early (<2 h) compared to delayed (12-72 h) intervention [17]. The original VERDICT trial (very early versus deferred invasive evaluation using computerized tomography) highlighted the potential benefits of immediate strategy in the high-risk category (GRACE score > 140) [18]. The GRACE risk score serves the purpose of stratifying risk among ACS and has demonstrated its superior predictive accuracy compared to other risk assessments [7]. But how effective is this risk stratification into two groups--high-risk versus non-high-risk? What if cases that are classified as non-high risk actually have their potential for a more severe prognosis masked by an inappropriate stratification model? To exclude this possibility, we should assume that our stratification risk is the most eloquent, with perfect congruity. There is no doubt that the GRACE score guided the management of these patients in an effective direction, but risk scores require permanent updates and greater perusal, not lesser. We believe that this perusal should involve revisiting some biological indicators closely related to myocardial infarction that were not included in the old scores. In this context, we aimed to evaluate new possible predictor markers in patients with myocardial infarction. As far as we know, this is the first study endeavoring to develop a risk assessment tool for NSTEMI patients that incorporates MCV, RDW, PDW, and MPV. The relationship between RDW and coronary artery disease (CAD) and other cardiovascular events can potentially be attributed to chronic low-grade inflammation, which serves as a plausible pathophysiological mechanism. Inflammation leads to the release of immature erythrocytes into the peripheral flow, resulting in anisocytosis [19]. Elevated levels of oxidative stress further contribute to the release of these premature erythrocytes into the circulation, reducing the lifespan of these cells and also leading to anisocytosis [20]. Most modern hematological analyzers can accurately assess anisocytosis, meaning the presence of red blood cells (RBCs) of varying sizes and volumes in the peripheral blood.