Impact of Chronic Thrombocytopenia on In-Hospital Outcomes After Percutaneous Coronary Intervention

JACC Cardiovasc Interv. 2018 Sep 24;11(18):1862-1868. doi: 10.1016/j.jcin.2018.05.033. Epub 2018 Aug 29.

Abstract

Objectives: This study sought to evaluate the impact of chronic thrombocytopenia (cTCP) on clinical outcomes after percutaneous coronary intervention (PCI).

Background: The impact of cTCP on clinical outcomes after PCI is not well described. Results from single-center observational studies and subgroup analysis of randomized trials have been conflicting and these patients are either excluded or under-represented in randomized controlled trials.

Methods: Using the 2012 to 2014 National (Nationwide) Inpatient Sample database, the study identified patients who underwent PCI with or without cTCP as a chronic condition variable indicator. Propensity score matching was performed using logistic regression to control for differences in baseline characteristics. The primary outcome of interest was in-hospital mortality. Secondary outcomes of interest included in-hospital post-PCI bleeding events, post-PCI blood and platelet transfusion, vascular complications, ischemic cerebrovascular accidents (CVAs), hemorrhagic CVAs, and length of stay.

Results: Propensity matching yielded a cohort of 65,130 patients (32,565 with and without cTCP). Compared with those without cTCP, PCI in patients with cTCP was associated with higher risk for bleeding complications (odds ratio [OR]: 2.40; 95% confidence interval [CI]: 2.05 to 2.72; p < 0.0001), requiring blood transfusion (OR: 2.10; 95% CI: 1.80 to 2.24; p < 0.0001), requiring platelet transfusion (OR: 11.70; 95% CI: 6.00 to 22.60; p < 0.0001), higher risk for vascular complications (OR: 1.94; 95% CI: 1.43 to 2.63; p < 0.0001), ischemic CVA (OR: 1.60; 95% CI: 1.20 to 2.10; p = 0.01), and higher in-hospital mortality (OR: 2.30; 95% CI: 1.90 to 2.70; p < 0.0001), but without a significant difference in hemorrhagic CVA (OR: 1.50; 95% CI: 0.70 to 3.10; p = 0.27).

Conclusions: In this large contemporary cohort, patients with cTCP were at higher risk of a multitude of complications, including higher risk of in-hospital mortality.

Keywords: complications; percutaneous coronary intervention; thrombocytopenia.

MeSH terms

  • Aged
  • Cerebrovascular Disorders / mortality
  • Chronic Disease
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / therapy*
  • Databases, Factual
  • Female
  • Hemorrhage / mortality
  • Hemorrhage / therapy
  • Hospital Mortality*
  • Humans
  • Inpatients
  • Length of Stay
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention / adverse effects
  • Percutaneous Coronary Intervention / mortality*
  • Platelet Transfusion / mortality
  • Risk Assessment
  • Risk Factors
  • Thrombocytopenia / blood
  • Thrombocytopenia / diagnosis
  • Thrombocytopenia / mortality*
  • Time Factors
  • Treatment Outcome
  • United States / epidemiology