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Updated: May 26, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Percutaneous coronary intervention in patients with acute coronary syndromes and increased platelet count
Yang Zhang1, Yongchen Hao2, Jun Liu2
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing 100029, China.
Insights
Percutaneous coronary intervention (PCI) effectively reduces ischemic events in acute coronary syndrome (ACS) patients with high platelet counts. This procedure lowers net adverse clinical events without increasing bleeding risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis Research
Background:
- Elevated platelet counts in acute coronary syndromes (ACS) correlate with higher risks of stent thrombosis and bleeding.
- Understanding the role of percutaneous coronary intervention (PCI) in managing ACS patients with thrombocytosis is crucial.
Purpose of the Study:
- To investigate the clinical benefits and outcomes of PCI in ACS patients with elevated platelet counts (≥300×10^9/L).
- To assess the association between PCI and net adverse clinical events (NACE) in this high-risk population.
Main Methods:
- Analysis of 4501 ACS patients from the Improving Care for Cardiovascular Disease in China-ACS Project (July 2017-December 2019).
- Comparison of NACE rates between patients who underwent PCI versus those who did not, using multivariable analysis and inverse probability of treatment weighting.
- Primary outcome: NACE (major adverse cardiovascular/cerebrovascular events and major bleeding).
Main Results:
- PCI rates decreased with increasing platelet counts; 3029 patients underwent PCI.
- PCI was associated with significantly lower NACE (adjusted OR: 0.53; P=0.001) and MACCE (adjusted OR: 0.44; P<0.001).
- No significant difference in major bleeding risk was observed between PCI and non-PCI groups (adjusted OR: 1.40; P=0.417).
Conclusions:
- PCI effectively reduces ischemic event risk in ACS patients with elevated platelet counts.
- The benefits of PCI in reducing NACE and MACCE are confirmed, even in patients with complex thrombohemorrhagic profiles.
- PCI does not appear to increase the risk of major bleeding in this patient cohort.
Background:
In patients with acute coronary syndromes (ACS) requiring percutaneous coronary intervention (PCI), abnormally elevated platelet counts are often associated with an increased risk of stent thrombosis and bleeding.
Aims:
To explore the associations between clinical benefits and PCI in patients with ACS and elevated platelet counts.
Methods:
Between July 2017 and December 2019, 50,009 patients with ACS were enrolled in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project. This study included patients with platelet count≥300×109/L. The primary outcome was net adverse clinical events (NACE), including major adverse cardiovascular or cerebrovascular events (MACCE; all-cause death, myocardial infarction, ischaemic stroke and stent thrombosis) and major bleeding during the index hospitalization. The difference in the risk of NACE between PCI and non-PCI groups was analysed using multivariable analysis and inverse probability of treatment weighting.
Results:
Among 4501 patients, PCI rates decreased as platelet count increased, with 3029 patients ultimately undergoing PCI. These patients exhibited a lower rate of NACE (adjusted odds ratio [OR]: 0.53, 95% confidence interval [95% CI]: 0.37-0.77; P=0.001) and a reduced risk of MACCE (OR: 0.44, 95% CI: 0.29-0.67; P<0.001). No significant differences in major bleeding were observed (adjusted OR: 1.40, 95% CI: 0.62-3.16; P=0.417). Inverse probability of treatment weighting confirmed these findings.
Conclusion:
In patients with ACS and increased platelet counts who have more complex thrombohaemorrhagic profiles, PCI can effectively reduce the risk of ischaemic events without increasing the risk of bleeding.
Clinical Trial Registration:
https://clinicaltrials.gov/study/NCT02306616.
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