Zhongxiu Chen1, Zheng Liu2, Nan Li3, Ran Liu3, Miye Wang3, Duolao Wang4, Chen Li1, Kai Li1, Fangbo Luo5, Yong He1. 1. Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China. 2. Department of Nursing, West China Hospital of Sichuan University, Chengdu, Sichuan, China. 3. Information Center of West China Hospital of Sichuan University, Chengdu, Sichuan, China. 4. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. 5. Department of Rehabilitation, Community Health Center of Huaxing Wuhou District, Chengdu, Sichuan, China.
Abstract
BACKGROUND: Thrombocytopenia was intuitively considered to be associated with higher risk of bleeding and multiple comorbidities after percutaneous coronary intervention (PCI). However, controversial results exist, and the real-world clinical impact of thrombocytopenia in patients undergoing PCI is largely unknown. The aim of this study was to evaluate the influence of baseline thrombocytopenia on the prognosis of patients undergoing PCI. METHODS: Using the West China Hospital Inpatient Sample database, patients who underwent PCI were identified from August 2012 to January 2019. Baseline thrombocytopenia was defined as a preprocedural platelet count of 100 × 109/L or less obtained from a routine blood sample taken within 48 hours before coronary PCI. The clinical effect of the advanced thrombocytopenia group (≤85 × 109/L), according to the median value of platelet count in the thrombocytopenia cohort, was further assessed. The primary outcome was a composite of in-hospital death, bleeding events, and post-PCI transfusion. RESULTS: Of 9531 patients enrolled in our study, 936 had baseline thrombocytopenia and 8595 patients did not have. There were no significant differences in the primary outcome between the two groups. However, advanced thrombocytopenia was independently associated with higher risk of primary outcome (OR 1.67, 95% CI 1.06 to 2.65, p = 0.029). Acute coronary syndrome (ACS) patients with thrombocytopenia were associated with higher odds of major bleeding (BARC ≥ 2) (OR 2.56, 95% CI 1.24 to 5.44, p = 0.011). Compared with the nonthrombocytopenia group, the thrombocytopenia group with ticagrelor use had higher odds of major bleeding (OR 9.7, 95% CI 1.57 to 60.4 versus OR 0.22, 95% CI 0.03 to 1.69, interaction p = 0.025). CONCLUSIONS: It seems feasible for patients with thrombocytopenia to receive PCI, but close attention should be paid to advanced thrombocytopenia, the risk of postprocedure bleeding in ACS patients, and the use of more potent P2Y12 inhibitor.
BACKGROUND: Thrombocytopenia was intuitively considered to be associated with higher risk of bleeding and multiple comorbidities after percutaneous coronary intervention (PCI). However, controversial results exist, and the real-world clinical impact of thrombocytopenia in patients undergoing PCI is largely unknown. The aim of this study was to evaluate the influence of baseline thrombocytopenia on the prognosis of patients undergoing PCI. METHODS: Using the West China Hospital Inpatient Sample database, patients who underwent PCI were identified from August 2012 to January 2019. Baseline thrombocytopenia was defined as a preprocedural platelet count of 100 × 109/L or less obtained from a routine blood sample taken within 48 hours before coronary PCI. The clinical effect of the advanced thrombocytopenia group (≤85 × 109/L), according to the median value of platelet count in the thrombocytopenia cohort, was further assessed. The primary outcome was a composite of in-hospital death, bleeding events, and post-PCI transfusion. RESULTS: Of 9531 patients enrolled in our study, 936 had baseline thrombocytopenia and 8595 patients did not have. There were no significant differences in the primary outcome between the two groups. However, advanced thrombocytopenia was independently associated with higher risk of primary outcome (OR 1.67, 95% CI 1.06 to 2.65, p = 0.029). Acute coronary syndrome (ACS) patients with thrombocytopenia were associated with higher odds of major bleeding (BARC ≥ 2) (OR 2.56, 95% CI 1.24 to 5.44, p = 0.011). Compared with the nonthrombocytopenia group, the thrombocytopenia group with ticagrelor use had higher odds of major bleeding (OR 9.7, 95% CI 1.57 to 60.4 versus OR 0.22, 95% CI 0.03 to 1.69, interaction p = 0.025). CONCLUSIONS: It seems feasible for patients with thrombocytopenia to receive PCI, but close attention should be paid to advanced thrombocytopenia, the risk of postprocedure bleeding in ACS patients, and the use of more potent P2Y12 inhibitor.
Authors: Donald E Cutlip; Stephan Windecker; Roxana Mehran; Ashley Boam; David J Cohen; Gerrit-Anne van Es; P Gabriel Steg; Marie-angèle Morel; Laura Mauri; Pascal Vranckx; Eugene McFadden; Alexandra Lansky; Martial Hamon; Mitchell W Krucoff; Patrick W Serruys Journal: Circulation Date: 2007-05-01 Impact factor: 29.690
Authors: Gregg W Stone; Bernhard Witzenbichler; Giulio Guagliumi; Jan Z Peruga; Bruce R Brodie; Dariusz Dudek; Ran Kornowski; Franz Hartmann; Bernard J Gersh; Stuart J Pocock; George Dangas; S Chiu Wong; Ajay J Kirtane; Helen Parise; Roxana Mehran Journal: N Engl J Med Date: 2008-05-22 Impact factor: 91.245
Authors: Pavlos Msaouel; Anthony P Lam; Krishna Gundabolu; Grigorios Chrysofakis; Yiting Yu; Ioannis Mantzaris; Ellen Friedman; Amit Verma Journal: Haematologica Date: 2014-02-07 Impact factor: 9.941
Authors: Mayank Yadav; Philippe Généreux; Gennaro Giustino; Mahesh V Madhavan; Sorin J Brener; Gary Mintz; Adriano Caixeta; Ke Xu; Roxana Mehran; Gregg W Stone Journal: Can J Cardiol Date: 2015-06-05 Impact factor: 5.223
Authors: Philip Urban; Roxana Mehran; Roisin Colleran; Dominick J Angiolillo; Robert A Byrne; Davide Capodanno; Thomas Cuisset; Donald Cutlip; Pedro Eerdmans; John Eikelboom; Andrew Farb; C Michael Gibson; John Gregson; Michael Haude; Stefan K James; Hyo-Soo Kim; Takeshi Kimura; Akihide Konishi; John Laschinger; Martin B Leon; P F Adrian Magee; Yoshiaki Mitsutake; Darren Mylotte; Stuart Pocock; Matthew J Price; Sunil V Rao; Ernest Spitzer; Norman Stockbridge; Marco Valgimigli; Olivier Varenne; Ute Windhoevel; Robert W Yeh; Mitchell W Krucoff; Marie-Claude Morice Journal: Circulation Date: 2019-05-22 Impact factor: 29.690