Effect of Baseline Thrombocytopenia on Ischemic Outcomes in Patients With Acute Coronary Syndromes Who Undergo Percutaneous Coronary Intervention.
BACKGROUND
Acquired thrombocytopenia (TP) has been associated with short- and long-term adverse outcomes after percutaneous coronary intervention (PCI), but the role of baseline TP is less well defined. We sought to evaluate the effect of TP on long-term adverse outcomes in patients with acute coronary syndromes (ACS) who undergo PCI.


METHODS
Data from 10,603 patients who underwent PCI for non-ST-elevation ACS or ST-elevation myocardial infarction were pooled from 2 large-scale randomized trials, Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) and Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI). Patients were stratified according to baseline platelet counts. Those with platelet counts <150,000/mm(3) were considered to have normal platelet counts. Adverse event rates were compared between groups with and without multivariable adjustment.


RESULTS
Baseline TP was present in 607 (5.7%) patients. The unadjusted 1-year rates of death (6.7% vs 3.6%; P < 0.0001), occurrence of major adverse cardiac event (MACE) (20.8% vs 15.6%; P = 0.0002), and target lesion revascularization (TLR; 9.4% vs 7.2%; P = 0.01) were significantly higher in patients with baseline TP compared with patients with normal platelet counts. By multivariable analysis, the presence of TP at baseline was an independent predictor of 1-year death (hazard ratio [HR], 1.74; 95% confidence interval [CI], 1.12-2.69; P = 0.01), ischemic TLR (HR, 1.37; 95% CI, 1.04-1.81; P = 0.03), and MACE (HR, 1.39; 95% CI, 1.09-1.79; P = 0.009).


CONCLUSIONS
The presence of baseline TP in the setting of ACS patients who undergo PCI was strongly predictive of death, ischemic TLR, and MACE at 1 year. Baseline TP might be a useful baseline clinical parameter to estimate future ischemic risk after PCI.
Cardiovascular Research Foundation, New York, New York.
Mayank
M
Yadav
Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada. Electronic address: pgenereux@crf.org.
Philippe
P
Généreux
Mount Sinai Medical Center, New York, New York.
Gennaro
G
Giustino
Columbia University Medical Center, New York, New York.
Mahesh V
MV
Madhavan
Cardiovascular Research Foundation, New York, New York; New York Methodist Hospital, New York, New York.
Sorin J
SJ
Brener
Cardiovascular Research Foundation, New York, New York.
Gary
G
Mintz
Hospital Israelita Albert Einstein and Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
Adriano
A
Caixeta
Cardiovascular Research Foundation, New York, New York.
Ke
K
Xu
Cardiovascular Research Foundation, New York, New York; Mount Sinai Medical Center, New York, New York.
Roxana
R
Mehran
Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
Gregg W
GW
Stone
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D000368:Aged; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D013921:Thrombocytopenia / Q000097:blood / Q000209:etiology*; D013923:Thromboembolism / Q000517:prevention & control*; D013997:Time Factors
D010975:Platelet Aggregation Inhibitors