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Full length article| Volume 121, ISSUE 11, P1304-1314, June 01, 2018

Impact of Baseline Thrombocytopenia on Bleeding and Mortality After Percutaneous Coronary Intervention

Published:March 01, 2018DOI:https://doi.org/10.1016/j.amjcard.2018.02.010
Impact of Baseline Thrombocytopenia on Bleeding and Mortality After Percutaneous Coronary Intervention
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      It is still controversial whether baseline thrombocytopenia is independently associated with adverse events after percutaneous coronary intervention. We evaluated the influence of baseline thrombocytopenia against ischemic, bleeding and mortality among the 19,353 patients whose baseline platelet counts were available in the pooled database from the 3 studies in Japan. Baseline thrombocytopenia was classified as follows: mild, ≥100 and <150 × 109/L; moderate, ≥50 and <100 × 109/L; and severe, <50 × 109/L. Primary ischemic outcome measure was defined as composite of myocardial infarction and ischemic stroke, and primary bleeding outcome measure was defined by the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded arteries trial as moderate or severe bleeding. There were 2,590 patients (13.4%) with baseline thrombocytopenia comprising 292 patients (1.5%) with moderate/severe (moderate: 277 and severe: 15) thrombocytopenia and 2,298 patients (11.9%) with mild thrombocytopenia, whereas 16,763 patients (86.6%) had no thrombocytopenia. During 3-year follow-up, the adjusted risks of moderate/severe and mild thrombocytopenia relative to none were neutral for primary ischemic outcome (hazard ratio [HR] 1.07 [95% confidence interval [CI] 0.72 to 1.60], p = 0.74, and HR 0.93 [0.79 to 1.09], p = 0.37, respectively) but were significantly higher for primary bleeding outcome (HR 2.35 [1.80 to 3.08], p <0.001, and HR 1.20 [1.03 to 1.40], p = 0.02), and for mortality (HR 2.34 [1.87 to 2.93], p <0.001, and HR 1.26 [1.11 to 1.43], p <0.001). In conclusion, patients with baseline thrombocytopenia, even a mild one, had a higher risk of bleeding events and all-cause death, but not for ischemic events after percutaneous coronary intervention.
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      Article Info

      Publication History

      Published online: March 01, 2018
      Accepted: February 6, 2018
      Received: November 15, 2017

      Footnotes

      See page 1313 for disclosure information.

      Clinical trials: The Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial [RESET]; NCT01035450 and NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial [NEXT]; NCT01303640. CREDO-Kyoto PCI/CABG registry cohort 2 was not registered.

      Identification

      DOI: https://doi.org/10.1016/j.amjcard.2018.02.010

      Copyright

      © 2018 Elsevier Inc. All rights reserved.

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