Shiraishi Jun, Koshi Nariko, Matsubara Yuki, Nishimura Tetsuro, Ito Daisuke, Kimura Masayoshi, Kishita Eigo, Nakagawa Yusuke, Hyogo Masayuki, Sawada Takahisa
Department of Cardiology, Kyoto First Red Cross Hospital, Japan.
Intern Med. 2019 Jun 15;58(12):1681-1688. doi: 10.2169/internalmedicine.2063-18. Epub 2019 Feb 25.
Objective The purpose of the present study was to examine the relationship between thrombocytopenia at baseline and in-hospital outcomes in unselected patients undergoing elective percutaneous coronary intervention (PCI) in Japan. Methods Among a total of 1,247 consecutive elective PCI-treated patients, patients with a baseline platelet count 150,000-449,000/μL and 50,000-149,000/μL were assigned to the normal platelet (n=1,009) and thrombocytopenia (n=226) groups, respectively. The thrombocytopenia group was further divided into the mild thrombocytopenia (100,000-149,000/μL, n=187) and moderate thrombocytopenia (50,000-99,000/μL, n=39) groups. Results The angiographic success rate of PCI and in-hospital mortality rate did not differ to a statistically significant extent between the normal platelet and thrombocytopenia groups or between the mild thrombocytopenia and moderate thrombocytopenia groups, whereas the moderate thrombocytopenia group had a significantly higher rate of access site-related bleeding complications than the normal platelet group. According to a multivariate analysis, moderate thrombocytopenia was an independent predictor of access site-related bleeding complications. Conclusion Among patients with mild to moderate thrombocytopenia, elective PCI might be feasible and effective in the short term; however, more attention should be paid to access site-related bleeding complications, particularly in patients with moderate thrombocytopenia.
目的 本研究旨在探讨在日本接受择期经皮冠状动脉介入治疗（PCI）的未选择患者中，基线血小板减少与住院结局之间的关系。方法 在总共1247例连续接受择期PCI治疗的患者中，基线血小板计数为150,000 - 449,000/μL和50,000 - 149,000/μL的患者分别被分配到正常血小板组（n = 1,009）和血小板减少组（n = 226）。血小板减少组进一步分为轻度血小板减少组（100,000 - 149,000/μL，n = 187）和中度血小板减少组（50,000 - 99,000/μL，n = 39）。结果 PCI的血管造影成功率和住院死亡率在正常血小板组与血小板减少组之间或轻度血小板减少组与中度血小板减少组之间没有统计学上的显著差异，而中度血小板减少组与穿刺部位相关的出血并发症发生率显著高于正常血小板组。根据多变量分析，中度血小板减少是穿刺部位相关出血并发症的独立预测因素。结论 在轻度至中度血小板减少的患者中，择期PCI短期内可能是可行且有效的；然而，应更加关注穿刺部位相关的出血并发症，特别是在中度血小板减少的患者中。
