Thrombocytopenia associated with worse outcomes after PCI
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The presence of moderate to severe thrombocytopenia before PCI is associated with increased risk for in-hospital mortality and shorter time to repeat revascularization compared with no or mild thrombocytopenia, researchers reported.
In an analysis of Department of Veterans Affairs data, researchers also found that any degree of thrombocytopenia is associated with increased long‐term all‐cause mortality after PCI, whereas moderate to severe thrombocytopenia was also associated with increased risk for periprocedural adverse events.
“Platelets play an important role in the pathogenesis of ACS, and the presence of thrombocytopenia has not been shown to protect against ACS,” Srikanth Vallurupalli, MD, assistant professor of medicine in the division of cardiology at the University of Arkansas for Medical Sciences and cardiologist at Central Arkansas Veterans Healthcare System, and colleagues wrote in the study background. “Simultaneously, thrombocytopenia can complicate PCI to treat CAD due to an increased risk of bleeding. Post‐PCI bleeding increases the risk of both short‐term and long‐term morbidity and mortality and risk mitigation is crucial in improving outcomes.”
Vallurupalli and colleagues analyzed data from 80,427 patients (98% men; 14% Black) who underwent PCI from October 2007 to September 2017, using data from the VA CART program. Researchers stratified patients by platelet count, defined as no thrombocytopenia (platelet count > 150,000/µL), mild thrombocytopenia (100,000 to 150,000/µL) or moderate to severe thrombocytopenia (< 100,000/µL). The primary outcome was all‐cause mortality during long‐term follow‐up after PCI.
The findings were published in Catheterization and Cardiovascular Interventions.
Within the cohort, 13.2% and 1.7% of men experienced mild or moderate to severe thrombocytopenia, respectively, at the time of PCI.
Compared with mild or no thrombocytopenia, moderate to severe thrombocytopenia was associated with increased risk for pericardiocentesis after PCI, with rates of 0.2% for both mild or no thrombocytopenia and 0.6% for moderate to severe (P = .018).
The rate of in-hospital mortality after PCI was also higher for patients with moderate to severe thrombocytopenia (1.5%) compared with mild or no thrombocytopenia (0.7% for both), with no between-group differences in stroke.
During a median follow‐up of 1,729 days, time‐to‐repeat revascularization was shorter for patients with moderate to severe thrombocytopenia (1,080 days) compared with no thrombocytopenia (1,347 days) or mild thrombocytopenia (1,467 days; P < .001) despite lower risk for revascularization.
Both mild (adjusted HR = 1.11; 95% CI, 1.07-1.15; P < .001) and moderate to severe thrombocytopenia (aHR = 1.55; 95% CI, 1.43-1.69; P < .001) conferred elevated risk for all‐cause mortality compared with those without thrombocytopenia.
“The severity of thrombocytopenia affected short‐term and long‐term outcomes but in different ways,” the researchers wrote. “Immediate post‐PCI complications (pericardial effusion, stroke, in‐hospital mortality) were significantly higher with moderate‐severe thrombocytopenia but not with mild thrombocytopenia. On the other hand, all‐cause mortality was higher with both mild and moderate‐severe thrombocytopenia in long‐term follow‐up.”
The researchers noted that a platelet count of less than 100,000/µL indicates higher risk for short‐term complications and “should trigger risk mitigation strategies.”
“In the long term, however, patients with even mild thrombocytopenia have higher risk of mortality,” the researchers wrote. “Further studies are necessary to understand the mechanisms by which thrombocytopenia affects prognosis after PCI.”
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