The Effect Of Perioperative Thrombocytopenia On The Long-term Prognosis Of Patients Undergoing Elective Percutaneous Coronary Intervention

BackgroundAcquired thrombocytopenia,a complication which was not rare in acute coronary syndrome(ACS)and percutaneous coronary intervention(PCI)in patients.Current guidelines for patients with acute coronary syndromes(ACS)recommend early invasive management with coricomitant antithrombotic therapy,including antithrombotic medications,Intra-aortic balloon pump(IABP),percutaneous coronary intervention(PCI),and coronary artery bypass grafting surgery(CABG).However these therapies may cause acquired thrombocytopenia and has been strongly associated with increased risk of hemorrhagic and ischemic complications,as well as early mortality.Up to date,few data exist regarding the impact of acquired thrombocytopenia on the long-term outcome of patients who underwent selective PCI for stable angina or low risk ACS.ObjectiveTo investigate the association between acquired thrombocytopenia and long-term clinical outcome among patients undergoing selective percutaneous coronary intervention(PCI).MethodsWe examined 8271 consecutive patients who underwent elective PCI in Fuwai Hospital from January 2013 to December 2013.Acquired thrombocytopenia was defined as platelet count<150 × 109/L after PCI with normal baseline value.We compared data on demographic,clinical,laboratory,and 30-month outcome between non-thrombocytopenic and thrombocytopenic patients.The primary study outcome including all-cause mortality and the development of major adverse cardiac events(MACE),cardiogenic mortality myocardial infarction,target vessel revascularization,stent thrombosis,and bleeding.Multivariate Cox analysis was used to determine independent predictors of Mortality and MACE.Multivariable logistic regression with logit link was used to identify factors associated with the development of thrombocytopenia.A two-tailed P value less than 0.05 was considered statistically significant for all comparisons.ResultsAt 30-month follow up,acquired thrombocytopenia developed in 654(7.91%)patients(634(7.67%)patients had mild thrombocytopenia,20(0.24%)patients had mild or severe type).Patients who developed thrombocytopenia had higher 30-month rate of all cause death(2.3%vs.1%,p=0.0086)and cardiogenic death(1.2%vs.0.5%,p=0.0261),Rates of MI,,bleeding,stent thrombosis tended to be higher among patients who had thrombocytopenia but without statistically significant.Mild thrombocytopenia was associated with increased risk for all-cause mortality(HR=2.079,95%CI:1.112-3.885,P=0.0218)and bleeding(HR=1.346,95%CI:1.001-1.809,P=0.0489)Moderate or severe thrombocytopenia were associated with a 13-fold increased risk for cardiogenic death(adjusted HR:13.578,95%CI:1.812-101.75,p=0.011),7-fold increased risk for stent thrombosis(adjusted HR:7.765,95%CI:1.064-56.679,p=0.043),11-fold increased risk for myocardial infarction(adjusted HR:11.309,95%CI:2.749-46.53,p=0.0008)compared with patients without thrombocytopenia.Baseline creatinine clearance(odds ratio(OR)0.993 for every unit increase,95%CI:0.989-0.996,p<0.001),baseline platelet count(OR:0.924 for every unit increase,95%CI:0.918-0.93,P<0.001)and diabetes mellitus history(OR:1.283,95%CI:1.056-1.558,P=0.0123)independently predicted acquired thrombocytopenia.ConclusionsAcquired thrombocytopenia was not rare and independently associated with long-term adverse outcome among patients who underwent selective PCI.Predictors of thrombocytopenia were baseline creatinine clearance,lower baseline platelet count and diabetes mellitus history.Background:Thrombocytopenia is an abnormality that is commonly observed in routine blood tests and is associated with inadequate platelet production and excessive platelet destruction·Acquired thrombocytopenia has been previously reported by several studies to be independently associated with adverse outcomes in patients who undergo percutaneous coronary intervention(PCI)for acute coronary syndromes(ACS),however,very few studies have investigated the effect of baseline TP on patient outcomes after PCI.Understanding the influence of baseline thrombocytopenia on the risks for major ischemic and bleeding events after PCI is important for risk stratification and appropriate clinical decisions regarding the duration of dual antiplatelet therapy(DAPT).Moreover,thus far,neither international guidelines nor any domestic expert consensus can provide specific suggestions on the safety of anti-thrombotic therapy in patients with TP.There are currently scarce data regarding the impact of baseline thrombocytopenia on the long-term outcome of patients undergoing elective PCI for stable angina or low risk ACS.MethodsWe examined 9897 consecutive patients who underwent elective PCI in Fuwai Hospital from January 2013 to December 2013.Baseline thrombocytopenia was defined as platelet count<150 × 109/L after PCI with normal baseline value.We compared data on demographic,clinical,laboratory,and 30-month outcome between non-thrombocytopenic and thrombocytopenic patients.The primary study outcome including all-cause mortality and the development of major adverse cardiac events(MACE)all-cause mortality,cardiogenic mortality,myocardial infarction,target lesion revascularization,stent thrombosis,and bleeding.Multivariate Cox analysis was used to determine independent predictors of Mortality and MACE.Multivariable logistic regression with logit link was used to identify factors associated with the development of thrombocytopenia,method.A two-tailed P value less than 0.05 was considered statistically significant for all comparisons.ResultsBaseline thrombocytopenia developed in 1263(12.76%)patients;of these,1,172(11.84%)patients had mild thrombocytopenia and 91(0.92%)had the moderate or severe type.No differences in all-cause mortality(1.0%VS 1.2%P=0.5148)?Cardiogenic death(0.6%vs0.6%P=0.9497)N myocardial infarction(0,7%vs 1.1%P=0.2212)?target vessel revascularization(4.6%vs 5.3%P=0.3106),bleeding(6.6%vs 6.7%P=0.8700)?major bleeding(1.3%vs 1.2%P=0.7260)complications or MACE(5.9%VS 6.8%P=0.3106)were detected between patients with and without thrombocytopenia.Further,advanced age(OR 1.093 95%CI 1.033-1.046 P<.0001),male sex(OR 2.531 95%CI 2.125-3.016 P=<.0001),previous PCI history(OR 1.267 95%CI 1.099-1.461 P=0.0011),previous myocardial infarction history(OR 1,234 95%CI 1.061-1.436 P=0.0065),and diabetes mellitus history(OR 1.307 95%CI 1.152-1.485 P<.0001)were found to be risk factors of baseline thrombocytopenia.ConclusionsAlthough baseline thrombocytopenia was common among patients who underwent elective PCI,it did not appear to have a clinically significant effect on long-term adverse outcomes,particular bleeding risk.Our results indicated that it seems to be feasible for patients with mild to moderate thrombocytopenia to receive elective PCI as well as guideline-recommended duration of anti-platelet therapy.