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Percutaneous Coronary Intervention in Acute Coronary Syndrome with Mild-to-Moderate Thrombocytopenia
Yicong Ye1, Yongchen Hao2, Xiliang Zhao1
1Department of Cardiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China.
Insights
Percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients with mild-to-moderate thrombocytopenia significantly reduces major adverse cardiac events and net adverse clinical events. However, it is associated with an increased risk of any bleeding, but not major bleeding.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Baseline thrombocytopenia is a frequent comorbidity in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).
- Mild-to-moderate thrombocytopenia is defined as a platelet count between 50 × 109/L and 150 × 109/L.
Purpose of the Study:
- To evaluate the safety and effectiveness of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) and mild-to-moderate baseline thrombocytopenia.
- To assess the association between PCI and in-hospital clinical outcomes, including major adverse cardiac events (MACE) and bleeding events.
Main Methods:
- Analysis of data from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome project, including 50,009 ACS patients.
- Focus on 6,413 patients with mild-to-moderate thrombocytopenia.
- Inverse probability treatment weighting (IPTW) method used to analyze associations between PCI and in-hospital outcomes (NACE, MACE, bleeding).
Main Results:
- Percutaneous coronary intervention (PCI) was associated with a significant reduction in in-hospital major adverse cardiac events (MACE) (OR: 0.45; 95% CI: 0.31-0.67) and net adverse clinical events (NACE) (OR: 0.59; 95% CI: 0.42-0.83).
- PCI was linked to an increased risk of any bleeding (OR: 1.56; 95% CI: 1.09-2.22) and minor bleeding (OR: 1.52; 95% CI: 1.00-2.30).
- No significant association was found between PCI and an increased risk of major bleeding (OR: 1.51; 95% CI: 0.76-2.98).
Conclusions:
- Percutaneous coronary intervention (PCI) demonstrates improved in-hospital outcomes compared to medical therapy alone in acute coronary syndrome (ACS) patients with mild-to-moderate thrombocytopenia.
- Further research is warranted to investigate the long-term prognostic implications of PCI in this patient cohort.
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.
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