Effect of Baseline Thrombocytopenia on Ischemic Outcomes in Patients With Acute Coronary Syndromes Who Undergo Percutaneous Coronary Intervention

Mayank Yadav, Philippe Genereux, Gennaro Giustino, Mahesh V. Madhavan, Sorin J. Brener, Gary Mintz, Adriano Caixeta, Ke Xu, Roxana Mehran, Gregg W. Stone

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Acquired thrombocytopenia (TP) has been associated with short- and long-term adverse outcomes after percutaneous coronary intervention (PCI), but the role of baseline TP is less well defined. We sought to evaluate the effect of TP on long-term adverse outcomes in patients with acute coronary syndromes (ACS) who undergo PCI. Methods: Data from 10,603 patients who underwent PCI for non-ST-elevation ACS or ST-elevation myocardial infarction were pooled from 2 large-scale randomized trials, Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) and Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI). Patients were stratified according to baseline platelet counts. Those with platelet counts <150,000/mm3 were considered to have normal platelet counts. Adverse event rates were compared between groups with and without multivariable adjustment. Results: Baseline TP was present in 607 (5.7%) patients. The unadjusted 1-year rates of death (6.7% vs 3.6%; P < 0.0001), occurrence of major adverse cardiac event (MACE) (20.8% vs 15.6%; P = 0.0002), and target lesion revascularization (TLR; 9.4% vs 7.2%; P = 0.01) were significantly higher in patients with baseline TP compared with patients with normal platelet counts. By multivariable analysis, the presence of TP at baseline was an independent predictor of 1-year death (hazard ratio [HR], 1.74; 95% confidence interval [CI], 1.12-2.69; P = 0.01), ischemic TLR (HR, 1.37; 95% CI, 1.04-1.81; P = 0.03), and MACE (HR, 1.39; 95% CI, 1.09-1.79; P = 0.009). Conclusions: The presence of baseline TP in the setting of ACS patients who undergo PCI was strongly predictive of death, ischemic TLR, and MACE at 1 year. Baseline TP might be a useful baseline clinical parameter to estimate future ischemic risk after PCI.

Original languageEnglish (US)
Pages (from-to)226-233
Number of pages8
JournalCanadian Journal of Cardiology
Volume32
Issue number2
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

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Percutaneous Coronary Intervention
Acute Coronary Syndrome
Thrombocytopenia
Platelet Count
Confidence Intervals
Triage
Catheterization
Stents
Myocardial Infarction
Mortality

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Yadav, Mayank ; Genereux, Philippe ; Giustino, Gennaro ; Madhavan, Mahesh V. ; Brener, Sorin J. ; Mintz, Gary ; Caixeta, Adriano ; Xu, Ke ; Mehran, Roxana ; Stone, Gregg W. / Effect of Baseline Thrombocytopenia on Ischemic Outcomes in Patients With Acute Coronary Syndromes Who Undergo Percutaneous Coronary Intervention. In: Canadian Journal of Cardiology. 2016 ; Vol. 32, No. 2. pp. 226-233.
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abstract = "Background: Acquired thrombocytopenia (TP) has been associated with short- and long-term adverse outcomes after percutaneous coronary intervention (PCI), but the role of baseline TP is less well defined. We sought to evaluate the effect of TP on long-term adverse outcomes in patients with acute coronary syndromes (ACS) who undergo PCI. Methods: Data from 10,603 patients who underwent PCI for non-ST-elevation ACS or ST-elevation myocardial infarction were pooled from 2 large-scale randomized trials, Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) and Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI). Patients were stratified according to baseline platelet counts. Those with platelet counts <150,000/mm3 were considered to have normal platelet counts. Adverse event rates were compared between groups with and without multivariable adjustment. Results: Baseline TP was present in 607 (5.7{\%}) patients. The unadjusted 1-year rates of death (6.7{\%} vs 3.6{\%}; P < 0.0001), occurrence of major adverse cardiac event (MACE) (20.8{\%} vs 15.6{\%}; P = 0.0002), and target lesion revascularization (TLR; 9.4{\%} vs 7.2{\%}; P = 0.01) were significantly higher in patients with baseline TP compared with patients with normal platelet counts. By multivariable analysis, the presence of TP at baseline was an independent predictor of 1-year death (hazard ratio [HR], 1.74; 95{\%} confidence interval [CI], 1.12-2.69; P = 0.01), ischemic TLR (HR, 1.37; 95{\%} CI, 1.04-1.81; P = 0.03), and MACE (HR, 1.39; 95{\%} CI, 1.09-1.79; P = 0.009). Conclusions: The presence of baseline TP in the setting of ACS patients who undergo PCI was strongly predictive of death, ischemic TLR, and MACE at 1 year. Baseline TP might be a useful baseline clinical parameter to estimate future ischemic risk after PCI.",
author = "Mayank Yadav and Philippe Genereux and Gennaro Giustino and Madhavan, {Mahesh V.} and Brener, {Sorin J.} and Gary Mintz and Adriano Caixeta and Ke Xu and Roxana Mehran and Stone, {Gregg W.}",
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Effect of Baseline Thrombocytopenia on Ischemic Outcomes in Patients With Acute Coronary Syndromes Who Undergo Percutaneous Coronary Intervention. / Yadav, Mayank; Genereux, Philippe; Giustino, Gennaro; Madhavan, Mahesh V.; Brener, Sorin J.; Mintz, Gary; Caixeta, Adriano; Xu, Ke; Mehran, Roxana; Stone, Gregg W.

In: Canadian Journal of Cardiology, Vol. 32, No. 2, 01.02.2016, p. 226-233.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of Baseline Thrombocytopenia on Ischemic Outcomes in Patients With Acute Coronary Syndromes Who Undergo Percutaneous Coronary Intervention

AU - Yadav, Mayank

AU - Genereux, Philippe

AU - Giustino, Gennaro

AU - Madhavan, Mahesh V.

AU - Brener, Sorin J.

AU - Mintz, Gary

AU - Caixeta, Adriano

AU - Xu, Ke

AU - Mehran, Roxana

AU - Stone, Gregg W.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Background: Acquired thrombocytopenia (TP) has been associated with short- and long-term adverse outcomes after percutaneous coronary intervention (PCI), but the role of baseline TP is less well defined. We sought to evaluate the effect of TP on long-term adverse outcomes in patients with acute coronary syndromes (ACS) who undergo PCI. Methods: Data from 10,603 patients who underwent PCI for non-ST-elevation ACS or ST-elevation myocardial infarction were pooled from 2 large-scale randomized trials, Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) and Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI). Patients were stratified according to baseline platelet counts. Those with platelet counts <150,000/mm3 were considered to have normal platelet counts. Adverse event rates were compared between groups with and without multivariable adjustment. Results: Baseline TP was present in 607 (5.7%) patients. The unadjusted 1-year rates of death (6.7% vs 3.6%; P < 0.0001), occurrence of major adverse cardiac event (MACE) (20.8% vs 15.6%; P = 0.0002), and target lesion revascularization (TLR; 9.4% vs 7.2%; P = 0.01) were significantly higher in patients with baseline TP compared with patients with normal platelet counts. By multivariable analysis, the presence of TP at baseline was an independent predictor of 1-year death (hazard ratio [HR], 1.74; 95% confidence interval [CI], 1.12-2.69; P = 0.01), ischemic TLR (HR, 1.37; 95% CI, 1.04-1.81; P = 0.03), and MACE (HR, 1.39; 95% CI, 1.09-1.79; P = 0.009). Conclusions: The presence of baseline TP in the setting of ACS patients who undergo PCI was strongly predictive of death, ischemic TLR, and MACE at 1 year. Baseline TP might be a useful baseline clinical parameter to estimate future ischemic risk after PCI.

AB - Background: Acquired thrombocytopenia (TP) has been associated with short- and long-term adverse outcomes after percutaneous coronary intervention (PCI), but the role of baseline TP is less well defined. We sought to evaluate the effect of TP on long-term adverse outcomes in patients with acute coronary syndromes (ACS) who undergo PCI. Methods: Data from 10,603 patients who underwent PCI for non-ST-elevation ACS or ST-elevation myocardial infarction were pooled from 2 large-scale randomized trials, Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) and Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI). Patients were stratified according to baseline platelet counts. Those with platelet counts <150,000/mm3 were considered to have normal platelet counts. Adverse event rates were compared between groups with and without multivariable adjustment. Results: Baseline TP was present in 607 (5.7%) patients. The unadjusted 1-year rates of death (6.7% vs 3.6%; P < 0.0001), occurrence of major adverse cardiac event (MACE) (20.8% vs 15.6%; P = 0.0002), and target lesion revascularization (TLR; 9.4% vs 7.2%; P = 0.01) were significantly higher in patients with baseline TP compared with patients with normal platelet counts. By multivariable analysis, the presence of TP at baseline was an independent predictor of 1-year death (hazard ratio [HR], 1.74; 95% confidence interval [CI], 1.12-2.69; P = 0.01), ischemic TLR (HR, 1.37; 95% CI, 1.04-1.81; P = 0.03), and MACE (HR, 1.39; 95% CI, 1.09-1.79; P = 0.009). Conclusions: The presence of baseline TP in the setting of ACS patients who undergo PCI was strongly predictive of death, ischemic TLR, and MACE at 1 year. Baseline TP might be a useful baseline clinical parameter to estimate future ischemic risk after PCI.

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JO - Canadian Journal of Cardiology

JF - Canadian Journal of Cardiology

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