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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Percutaneous coronary intervention in patients with essential thrombocythemia: case reports and literature review
Yaguo Zheng1, Tian Xu1, Liang Chen1
1Department of Cardiology, Nanjing First Hospital, Nanjing Medical University , Nanjing, Jiangsu, China.
Insights
Percutaneous coronary intervention (PCI) effectively revascularizes patients with essential thrombocythemia (ET). However, this patient group faces increased risks of stent thrombosis and restenosis after PCI, requiring careful monitoring.
Area of Science:
- Cardiology
- Hematology
- Interventional Cardiology
Background:
- Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by elevated platelet counts, increasing the risk of systemic thrombosis.
- Coronary artery involvement in ET is uncommon, making the management of these patients challenging.
Observation:
- This retrospective study analyzed eight patients with ET who underwent percutaneous coronary intervention (PCI) for coronary heart disease between 2012 and 2018.
- Patients presented with various angina types and myocardial infarction, with an average platelet count of 722 × 10^9/L. Hydroxyurea was administered to seven patients.
- All patients received drug-eluting stents (DES) via PCI for single-vessel lesions, followed by dual antiplatelet therapy.
Findings:
- PCI successfully revascularized all eight ET patients.
- During follow-up, one patient developed stent thrombosis, and two experienced stent restenosis, indicating potential complications.
- The study highlights a possible increased risk of stent-related complications in ET patients post-PCI.
Implications:
- Percutaneous coronary intervention (PCI) is a viable revascularization strategy for essential thrombocythemia (ET) patients with coronary heart disease.
- The findings suggest that ET patients undergoing PCI may have a higher incidence of stent thrombosis and restenosis.
- Close monitoring and potentially tailored antiplatelet strategies are warranted for ET patients post-PCI to mitigate these risks.
Abstract:
Essential thrombocythemia (ET) can cause systemic vascular thrombosis, but the involvement of coronary arteries is rare. This study is aimed to analyze the characteristics, treatment, and prognosis during follow-up in patients with ET after percutaneous coronary intervention (PCI). A total of eight patients with ET who had coronary heart disease and treated with PCI in our hospital from 2012 to 2018 were retrospectively studied. The basic clinical information with clinical data, data of coronary intervention, application of anti-platelet and platelet reducing drugs, and the results of long-term follow-up were recorded. There were five males and three females with a median age of 67 years. Clinical presentation was unstable angina in four cases, stable angina in one case, ST-elevation myocardial infarction in two cases, and non-ST elevation myocardial infarction in one case. The average platelet count was 722 × 109/L in admission, and hydroxyurea was used in seven cases. Coronary angiography suggested that all eight cases were single-vessel lesion. All the patients received PCI treatment, and Drug-eluting stent (DES) was used in all cases. Six were treated with one stent, one was treated with two stents and one was treated with three stents. After PCI, aspirin, and clopidogrel (or ticagrelor) were used in all cases. During the follow-up, one developed stent thrombus 2 months later, two developed stent restenosis 1 year later. In conclusion, PCI is an effective method of revascularization in patients with ET; but it may be associated with a higher rate of complications including stent thrombus and restenosis.
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