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Thromb Haemost
DOI: 10.1055/a-2225-5263
Cellular Haemostasis and Platelets

Percutaneous Coronary Intervention in Acute Coronary Syndrome with Mild-to-Moderate Thrombocytopenia

Yicong Ye‡   *
1   Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
,
Yongchen Hao‡   *
2   Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
,
Xiliang Zhao
1   Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
,
Jun Liu
2   Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
,
Na Yang
2   Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
,
Sidney C. Smith Jr
3   Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, United States
,
Yong Huo
4   Department of Cardiology, Peking University First Hospital, Beijing, China
,
Gregg C. Fonarow
5   Division of Cardiology, Geffen School of Medicine at University of California, Los Angeles, California, United States
,
Junbo Ge
6   Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Fudan University, Zhongshan Hospital, Shanghai, China
,
Louise Morgan
7   International Quality Improvement Department, American Heart Association, Dallas, Texas, United States
,
Zhaoqing Sun
2   Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
,
Danqing Hu
2   Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
,
Yiqian Yang
2   Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
,
Chang-Sheng Ma
1   Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
,
Dong Zhao
2   Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
,
Yaling Han
8   Department of Cardiology, Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
,
Jing Liu
2   Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
,
Yong Zeng
1   Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
› Author Affiliations Funding This work was supported by a collaborative program of the American Heart Association and the Chinese Society of Cardiology. The American Heart Association received funding from Pfizer through an independent grant for learning and change and AstraZeneca as a quality improvement initiative.
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Abstract

Background Baseline thrombocytopenia is commonly observed in patients with acute coronary syndrome (ACS) requiring percutaneous coronary intervention (PCI).

Aim The purpose of this analysis was to investigate safety and effectiveness of PCI in ACS patients with baseline mild-to-moderate thrombocytopenia.

Methods The data were collected from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome project. A total of 50,009 ACS patients were recruited between July 2017 and December 2019. Among them, there were 6,413 patients with mild-to-moderate thrombocytopenia, defined as a platelet count of ≥50 × 109/L and <150 × 109/L on admission. The primary outcome was in-hospital net adverse clinical events (NACE), consisting of major adverse cardiac events (MACE) and major bleeding events. The associations between PCI and in-hospital outcomes were analyzed by inverse probability treatment weighting (IPTW) method.

Results PCI was performed in 4,023 of 6,413 patients (62.7%). The IPTW analysis showed that PCI was significantly associated with a reduced risk of in-hospital MACE (odd ratio [OR]: 0.45; 95% confidence interval [CI]: 0.31–0.67; p < 0.01) and NACE (OR: 0.59; 95% CI: 0.42–0.83; p < 0.01). PCI was also associated with an increased risk of any bleeding (OR: 1.56; 95% CI: 1.09–2.22; p = 0.01) and minor bleeding (OR: 1.52; 95% CI: 1.00–2.30; p = 0.05), but not major bleeding (OR: 1.51; 95% CI: 0.76–2.98; p = 0.24).

Conclusion Compared with medical therapy alone, PCI is associated with better in-hospital outcomes in ACS patients with mild-to-moderate thrombocytopenia. Further studies with long-term prognosis are needed.

Keywords

thrombocytopenia - acute coronary syndrome - percutaneous coronary intervention - platelet

Ethics Approval Statement

The present study was registered at URL: https://www.clinicaltrials.gov (Unique identifier: NCT02306616), approved by the Ethics Committee of the Beijing Anzhen Hospital, Capital Medical University with a waiver for informed consent, and performed in compliance with the Declaration of Helsinki. All methods were performed in accordance with relevant guidelines and regulations.


Data Availability Statement

The datasets generated and/or analyzed during the current study are not publicly available due to the decision of the study committee, but are available from the corresponding author on reasonable request.


Authors' Contribution

Y.H. and Y.Z. conceived of the study, designed the study, and revised the paper. Y.Y. and Y.H. performed the research, analyzed data, and wrote the paper. The remaining authors contributed to refining the ideas and finalizing this paper. All authors read and approved the final manuscript.


* These authors contributed equally to the study.


Supplementary Material



Publication History

Received: 24 April 2023

Accepted: 08 December 2023

Accepted Manuscript online:
11 December 2023

Article published online:
10 January 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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