Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York.
Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York; Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System, New York.
Am J Med. 2019 Aug;132(8):942-948.e5. doi: 10.1016/j.amjmed.2019.04.003. Epub 2019 Apr 27.
The impact of thrombocytopenia on revascularization and outcomes in patients presenting with acute myocardial infarction remains poorly understood. We sought to evaluate associations between thrombocytopenia, in-hospital management, bleeding, and cardiovascular outcomes in patients hospitalized for acute myocardial infarction in the United States.
Patients hospitalized from 2004 to 2014 with a primary diagnosis of acute myocardial infarction were identified from the National Inpatient Sample. Management of acute myocardial infarction was compared between patients with and without thrombocytopenia. Multivariable logistic regression models were used to estimate odds of in-hospital adverse events stratified by thrombocytopenia and adjusted for demographics, cardiovascular risk factors, comorbidities, and treatment.
A total of 6,717,769 patients were hospitalized with a primary diagnosis of acute myocardial infarction, and thrombocytopenia was reported in 219,351 (3.3%). Patients with thrombocytopenia were older, more likely to have other medical comorbidities, were more likely to undergo coronary artery bypass grafting (28.8% vs 8.2%, P < .001), and were less likely to receive a drug-eluting stent (15.5% vs 29.5%, P < .001). After multivariable adjustment, thrombocytopenia was independently associated with nearly twofold increased odds of in-hospital mortality (adjusted odds ratio 1.91; 95% confidence interval, 1.86-1.97). Thrombocytopenia was also independently associated with ischemic stroke, cardiogenic shock, cardiac arrest, and bleeding complications.
Patients with thrombocytopenia in the setting of acute myocardial infarction had increased odds of bleeding, cardiovascular outcomes, and mortality compared with patients without thrombocytopenia. Future investigations to mitigate the poor prognosis of patients with acute myocardial infarction and thrombocytopenia are warranted.
血小板减少症对急性心肌梗死患者血运重建和结局的影响仍不清楚。我们旨在评估美国因急性心肌梗死住院患者血小板减少症、院内管理、出血和心血管结局之间的关联。
从国家住院患者样本中确定了 2004 年至 2014 年间因急性心肌梗死初次诊断住院的患者。比较了血小板减少症患者与非血小板减少症患者的急性心肌梗死管理情况。使用多变量逻辑回归模型，根据血小板减少症分层，调整了人口统计学、心血管危险因素、合并症和治疗因素，估计了住院期间不良事件的发生几率。
共有 6717769 名患者因急性心肌梗死初次诊断住院，其中 219351 名（3.3%）报告有血小板减少症。血小板减少症患者年龄较大，更有可能患有其他合并症，更有可能接受冠状动脉旁路移植术（28.8%比 8.2%，P<0.001），而不太可能接受药物洗脱支架（15.5%比 29.5%，P<0.001）。经过多变量调整，血小板减少症与院内死亡率增加近两倍的几率独立相关（调整后的优势比 1.91；95%置信区间，1.86-1.97）。血小板减少症也与缺血性卒中、心源性休克、心脏骤停和出血并发症独立相关。
与无血小板减少症的患者相比，急性心肌梗死后血小板减少症患者的出血、心血管结局和死亡率的几率增加。有必要进一步研究以减轻急性心肌梗死和血小板减少症患者的不良预后。
