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基线血小板减少对择期经皮冠状动脉介入治疗患者长期预后的影响:连续 9897 例患者的分析。

Impact of baseline thrombocytopenia on the long-term outcome of patients undergoing elective percutaneous coronary intervention: An analysis of 9,897 consecutive patients.

机构信息

Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China.

出版信息

Catheter Cardiovasc Interv. 2019 Feb 15;93(S1):764-771. doi: 10.1002/ccd.28030. Epub 2018 Dec 26.

Abstract

OBJECTIVES

This study aimed to investigate the association between baseline thrombocytopenia and long-term clinical outcomes among patients undergoing elective percutaneous coronary intervention (PCI).

BACKGROUND

Thrombocytopenia (TP) commonly occurs among patients undergoing PCI. However, whether TP has any influence on the outcome of PCI patients remains controversial.

METHODS

We examined 9,897 consecutive patients who underwent elective PCI in Fuwai Hospital from January 2013 to December 2013. Baseline thrombocytopenia was defined as platelet count <150 × 10 /L. We compared data on demographic, clinical, laboratory, and 30-month outcomes between nonthrombocytopenic and thrombocytopenic patients. The primary outcome was death and major adverse cardiovascular events (MACE) during the 30-month follow-up. Logistic regression analyses were performed to identify risk factors of baseline thrombocytopenia.

RESULTS

Baseline thrombocytopenia developed in 1263 (12.76%) patients; of these, 1,172 (11.84%) patients had mild thrombocytopenia and 91 (0.92%) had the moderate or severe type. No differences in all-cause mortality, stent thrombosis, target vessel revascularization, MACE, or bleeding complications were detected between patients with and without thrombocytopenia. Further, advanced age, male sex, previous PCI history, previous myocardial infarction history, and diabetes mellitus history were found to be risk factors of baseline thrombocytopenia.

CONCLUSIONS

Although baseline thrombocytopenia was common among patients who underwent elective PCI, it did not appear to have a clinically significant effect on long-term adverse outcomes, particular bleeding risk. Our results indicated that it seems to be feasible for patients with mild to moderate thrombocytopenia to receive elective PCI as well as guideline-recommended duration of anti-platelet therapy.

摘要

目的

本研究旨在探讨接受择期经皮冠状动脉介入治疗(PCI)的患者基线血小板减少症与长期临床结局之间的关系。

背景

血小板减少症(TP)在接受 PCI 的患者中很常见。然而,TP 是否对 PCI 患者的结局有影响仍存在争议。

方法

我们检查了 2013 年 1 月至 12 月期间在阜外医院接受择期 PCI 的 9897 例连续患者。基线血小板减少症定义为血小板计数<150×10/L。我们比较了非血小板减少症和血小板减少症患者的人口统计学、临床、实验室和 30 个月结局数据。主要结局是 30 个月随访期间的死亡和主要不良心血管事件(MACE)。进行逻辑回归分析以确定基线血小板减少症的危险因素。

结果

基线血小板减少症发生在 1263 例(12.76%)患者中;其中 1172 例(11.84%)患者为轻度血小板减少症,91 例(0.92%)为中重度血小板减少症。血小板减少症患者和无血小板减少症患者之间的全因死亡率、支架血栓形成、靶血管血运重建、MACE 或出血并发症无差异。此外,高龄、男性、既往 PCI 史、既往心肌梗死史和糖尿病史是基线血小板减少症的危险因素。

结论

尽管接受择期 PCI 的患者中基线血小板减少症很常见,但它似乎不会对长期不良结局产生显著影响,特别是出血风险。我们的结果表明,对于轻度至中度血小板减少症患者,似乎可以接受择期 PCI 以及指南推荐的抗血小板治疗时间。

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