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Published on: November 8, 2024
Baseline platelet count in percutaneous coronary intervention: a dose-response meta-analysis
Akhmetzhan Galimzhanov1, Yersyn Sabitov2, Erhan Tenekecioglu3,4
1Department of Cardiology and Interventional Arrhythmology, Semey Medical University, Semey, Kazakhstan ahmed.galimzhan@gmail.com.
Insights
Baseline platelet counts significantly impact outcomes after percutaneous coronary intervention (PCI). Low counts increase bleeding risk, while high counts are linked to ischemic events, affecting mortality and major adverse cardiovascular events.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Interventional Cardiology
Background:
- The prognostic value of baseline platelet count in patients undergoing percutaneous coronary intervention (PCI) remains incompletely understood.
- Understanding this relationship is crucial for risk stratification and management post-PCI.
Purpose of the Study:
- To elucidate the dose-response relationship between baseline platelet count and clinical outcomes following PCI.
- To assess the prognostic significance of platelet count for mortality, major adverse cardiovascular events (MACE), and bleeding.
Main Methods:
- A comprehensive meta-analysis of published studies was conducted, searching PubMed, Scopus, and Web of Science.
- Included 19 studies with 217,459 patients, analyzing associations between platelet count and clinical endpoints.
- Employed random-effects pairwise and dose-response meta-analyses to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).
Main Results:
- A J-shaped relationship was observed between baseline platelet counts and outcomes, including all-cause death, MACE, and major bleeding.
- Low platelet counts (<175×10^9/L) were associated with a higher risk of bleeding events.
- High platelet counts (>250×10^9/L) were predominantly linked to an increased risk of ischemic events.
Conclusions:
- Baseline platelet count is a significant predictor of clinical outcomes after PCI.
- Thrombocytopenia (low platelet count) is primarily associated with bleeding risk.
- Thrombocytosis (high platelet count) is mainly associated with ischemic risk, impacting mortality and MACE.
Objectives:
The nature of the relationship between baseline platelet count and clinical outcomes following percutaneous coronary intervention (PCI) is unclear. We undertook dose-response and pairwise meta-analyses to better describe the prognostic value of the initial platelet count and clinical endpoints in patients after PCI.
Methods:
A search of PubMed, Scopus and Web of Science (up to 9 October 2021) was performed to identify studies that evaluated the association between platelet count and clinical outcomes following PCI. The primary outcomes of interest were all-cause mortality, major adverse cardiovascular events (MACE) and major bleeding. We performed random-effects pairwise and one-stage dose-response meta-analyses by calculating HRs and 95% CIs.
Results:
The meta-analysis included 19 studies with 217 459 patients. We report a J-shaped relationship between baseline thrombocyte counts and all-cause death, MACE and major bleeding at follow-up. The risk of haemorrhagic events exceeded the risk of thrombotic events at low platelet counts (<175×109/L), while a predominant ischaemic risk was observed at high platelet counts (>250×109/L). Pairwise meta-analyses revealed a robust link between initial platelet counts and the risk of postdischarge all-cause mortality, major bleeding (for thrombocytopenia: HR 1.39, 95% CI 1.30 to 1.49; HR 1.51, 95% CI 1.15 to 2.00, respectively) and future death from any cause and MACE (thrombocytosis: HR 1.60, 95% CI 1.29 to 1.98; HR 1.47, 95% CI 1.22 to 1.78, respectively).
Conclusion:
Low platelet counts were associated with the predominant bleeding risk, while high platelet counts were only associated with the ischaemic events.
Prospero Registration Number:
CRD42021283270.
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