Ischemic and Bleeding Events Associated with Thrombocytopenia and Thrombocytosis after Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

Abstract

The early and late ischemic and bleeding clinical outcomes according to baseline platelet count after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) remain unclear. Overall, 10,667 patients from the Cardiovascular Risk and identification of potential high-risk population in AMI (COREA-AMI) I and II registries were classified according to the following universal criteria on baseline platelet counts: (1) moderate to severe thrombocytopenia (platelet < 100 K/μL, n = 101), (2) mild thrombocytopenia (platelet = 100~149 K/μL, n = 631), (3) normal reference (platelet = 150~450 K/μL, n = 9832), and (4) thrombocytosis (platelet > 450 K/μL, n = 103). The primary endpoint was the occurrence of major adverse cardiovascular events (MACE). The secondary outcome was Bleeding Academic Research Consortium (BARC) 2, 3, and 5 bleeding. After adjusting for confounders, the moderate to severe thrombocytopenia (HR, 2.03; 95% CI, 1.49–2.78); p < 0.001), mild thrombocytopenia (HR, 1.15; 95% CI, 1.01–1.34; p = 0.045), and thrombocytosis groups (HR, 1.47; 95% CI, 1.07–2.03; p = 0.019) showed higher 5-year MACE rates than the normal reference. In BARC 2, 3, and 5 bleeding outcomes, the bleedings rates were higher than the normal range in the moderate to severe thrombocytopenia (HR, 2.18; 95% CI, 1.36–3.49; p = 0.001) and mild thrombocytopenia (HR, 1.41; 95% CI, 1.12–1.78; p = 0.004) groups. Patients with AMI had higher 5-year MACE rates after PCI if they had lower- or higher-than-normal platelet counts. Thrombocytopenia revealed higher early and late bleeding rates whereas thrombocytosis showed long-term bleeding trends, although these trends were not statistically significant.

Gender Differences in the Impact of New-Onset Atrial Fibrillation on Long-Term Risk of Ischemic Stroke after Acute Myocardial Infarction

“…We conducted a prospective cohort study using data from the CardiOvascular Risk and idEntification of potential high-risk population in AMI (COREA-AMI) registry. The details of the registry have been published [ 17 ]. In brief, the COREA-AMI is a prospective, multicenter registry used to evaluate the outcomes of AMI patients in real-world clinical practice and involved consecutive patients (age > 20 years) who presented to nine nation-wide hospitals with a final diagnosis of AMI and were treated with percutaneous coronary intervention (PCI) using stents from January 2004 to August 2014.…”

Baseline platelet count in percutaneous coronary intervention: a dose–response meta-analysis

“…After a comprehensive search, we identified 19 studies with 217 459 participants 4–9 11–13 28 37–45 Figure 1. illustrates the flow diagram of the search strategy used.…”

“…Generally, patients from the included studies adequately represent the population of interest. Study attrition bias was rated as moderate in the studies that did not report percentage of lost to follow-up population 4 6–9 11–13 28 40 45. One study reported 14% missing follow-up data without providing any reasons, that is why this study was regarded as of high risk of attrition bias 43.…”

“…Previous studies have suggested that thrombocytopenia is associated with both an increase in major bleeding and ischaemic events, with no consideration around whether this balance changes across different platelet counts. Furthermore, few studies have investigated the prognostic value of thrombocytosis11–13 with some studies considering platelet count as a linear variable 14. While few studies have attempted to examine non-linear relationships between platelet counts and clinical outcomes,6 12 no dose–response meta-analysis has been conducted yet, and no consideration has been given to quantify net effect on bleeding/ischaemic risk at different platelet counts.…”

“…Furthermore, few studies have investigated the prognostic value of thrombocytosis11–13 with some studies considering platelet count as a linear variable 14. While few studies have attempted to examine non-linear relationships between platelet counts and clinical outcomes,6 12 no dose–response meta-analysis has been conducted yet, and no consideration has been given to quantify net effect on bleeding/ischaemic risk at different platelet counts. We, therefore, undertook a systematic review and meta-analysis to explore and quantify the relationship across the full continuum of baseline platelet counts and clinical outcomes after PCI.…”