Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Italy; Sant'Anna Hospital, Catanzaro, Italy.
Sant'Anna Hospital, Catanzaro, Italy.
Vascul Pharmacol. 2014 Jan;60(1):25-31. doi: 10.1016/j.vph.2013.11.002. Epub 2013 Nov 15.
Thrombocytopenia (TC) following a percutaneous coronary intervention (PCI) has been associated not only with hemorrhagic, but also with ischemic outcomes. The purpose of this study was to re-examine the relationship of TC with ischemic events at a 1-year follow-up, and investigate the possible associations.
We studied a real-world, unselected population of ischemic patients undergoing PCI, totaling 861 patients-year, and divided into two groups: with TC (delta platelet count ≥25% from baseline to post-PCI during the hospital admission) and without TC. Compared with patients without TC, patients with TC had a higher and earlier incidence of both hemorrhagic and ischemic events. In them, the use of intra-aortic balloon pump (IABP) was ten-fold higher. In Kaplan-Meier curves assessing the contribution of both TC and IABP to outcome, IABP was a univariate detrimental factor additive to the role of TC. In a forced Cox model, the relative decline (delta) in platelet count (p=0.05) and the use of IABP (p=0.0001) were both associated with ischemic outcomes. After excluding all patients with IABP, the delta platelet count was no longer significantly associated with ischemic outcomes (p=0.66). After excluding all patients with shock and all those who undergone thrombolysis, there was still a relationship (p=0.0042) between the delta platelet count and ischemic events.
In this patient population the use of IABP, but not thrombocytopenia per se, is a possible primary cause of worse ischemic outcomes.
经皮冠状动脉介入治疗（PCI）后血小板减少症（TC）不仅与出血有关，而且与缺血事件有关。本研究的目的是在 1 年随访时重新检查 TC 与缺血事件的关系，并探讨可能的关联。
我们研究了一个真实的、未经选择的接受 PCI 的缺血患者人群，共 861 例患者年，分为两组：TC 组（从基线到住院期间 PCI 后血小板计数下降≥25%）和非 TC 组。与无 TC 组相比，TC 组患者的出血和缺血事件发生率更高且更早。在 TC 组患者中，使用主动脉内球囊泵（IABP）的比例高十倍。在评估 TC 和 IABP 对结局影响的 Kaplan-Meier 曲线中，IABP 是 TC 作用的附加单一不利因素。在强制 Cox 模型中，血小板计数的相对下降（p=0.05）和 IABP 的使用（p=0.0001）均与缺血结局相关。排除所有使用 IABP 的患者后，血小板计数的下降（p=0.66）与缺血结局不再显著相关。排除所有休克患者和所有接受溶栓治疗的患者后，血小板计数的下降（p=0.0042）与缺血事件仍存在相关性。
在本患者人群中，IABP 的使用，而不是血小板减少症本身，可能是缺血结局恶化的一个主要原因。
