Ito Shinya, Watanabe Hirotoshi, Morimoto Takeshi, Yoshikawa Yusuke, Shiomi Hiroki, Shizuta Satoshi, Ono Koh, Yamaji Kyohei, Soga Yoshimitsu, Hyodo Makoto, Shirai Shinichi, Ando Kenji, Horiuchi Hisanori, Kimura Takeshi
Division of Cardiology, Kokura Memorial Hospital, Kitakyusyu, Japan.
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Am J Cardiol. 2018 Jun 1;121(11):1304-1314. doi: 10.1016/j.amjcard.2018.02.010. Epub 2018 Mar 1.
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 × 10/L; moderate, ≥50 and <100 × 10/L; and severe, <50 × 10/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.
经皮冠状动脉介入治疗后，基线血小板减少症是否与不良事件独立相关仍存在争议。我们在日本三项研究的汇总数据库中，评估了19353例有基线血小板计数患者的基线血小板减少症对缺血、出血和死亡率的影响。基线血小板减少症分类如下：轻度，≥100且<150×10⁹/L；中度，≥50且<100×10⁹/L；重度，<50×10⁹/L。主要缺血结局指标定义为心肌梗死和缺血性卒中的复合指标，主要出血结局指标根据链激酶和组织型纤溶酶原激活剂在闭塞动脉中的全球应用试验定义为中度或重度出血。有2590例患者（13.4%）存在基线血小板减少症，其中292例患者（1.5%）为中度/重度（中度：277例，重度：15例）血小板减少症，2298例患者（11.9%）为轻度血小板减少症，而16763例患者（86.6%）无血小板减少症。在3年随访期间，相对于无血小板减少症患者，中度/重度和轻度血小板减少症患者的主要缺血结局调整风险为中性（风险比[HR]1.07[95%置信区间[CI]0.72至1.60]，p = 0.74，以及HR 0.93[0.79至1.09]，p = 0.37），但主要出血结局风险显著更高（HR 2.35[1.80至3.08]，p<0.001，以及HR 1.20[1.03至1.40]，p = 0.02），死亡率风险也显著更高（HR 2.34[1.87至2.93]，p<0.001，以及HR 1.26[1.11至1.43]，p<0.001）。总之，基线血小板减少症患者，即使是轻度患者，经皮冠状动脉介入治疗后发生出血事件和全因死亡的风险更高，但缺血事件风险并非如此。
