Baseline platelet count in percutaneous coronary intervention: a dose-response meta-analysis


Galimzhanov A. Sabitov Y. Tenekecioglu E. Tun H.N. Alasnag M. Mamas M.A.
25 May 2022BMJ Publishing Group

Heart
2022#108Issue 221792 - 1799 pp.

Objectives The nature of the relationship between baseline platelet count and clinical outcomes following percutaneous coronary intervention (PCI) is unclear. We undertook dose-response and pairwise meta-analyses to better describe the prognostic value of the initial platelet count and clinical endpoints in patients after PCI. Methods A search of PubMed, Scopus and Web of Science (up to 9 October 2021) was performed to identify studies that evaluated the association between platelet count and clinical outcomes following PCI. The primary outcomes of interest were all-cause mortality, major adverse cardiovascular events (MACE) and major bleeding. We performed random-effects pairwise and one-stage dose-response meta-analyses by calculating HRs and 95% CIs. Results The meta-analysis included 19 studies with 217 459 patients. We report a J-shaped relationship between baseline thrombocyte counts and all-cause death, MACE and major bleeding at follow-up. The risk of haemorrhagic events exceeded the risk of thrombotic events at low platelet counts (<175×10 9 /L), while a predominant ischaemic risk was observed at high platelet counts (>250×10 9 /L). Pairwise meta-analyses revealed a robust link between initial platelet counts and the risk of postdischarge all-cause mortality, major bleeding (for thrombocytopenia: HR 1.39, 95% CI 1.30 to 1.49; HR 1.51, 95% CI 1.15 to 2.00, respectively) and future death from any cause and MACE (thrombocytosis: HR 1.60, 95% CI 1.29 to 1.98; HR 1.47, 95% CI 1.22 to 1.78, respectively). Conclusion Low platelet counts were associated with the predominant bleeding risk, while high platelet counts were only associated with the ischaemic events. PROSPERO registration number CRD42021283270.

acute coronary syndrome , coronary artery disease , meta-analysis , percutaneous coronary intervention , systematic reviews as topic

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Department of Cardiology and Interventional Arrhythmology, Semey Medical University, Semey, Kazakhstan
Rentgen-endovascular Laboratory, Semey Medical University, East Kazakhstan, Semey, Kazakhstan
Department of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
Department of Cardiology, Erasmus University Rotterdam, Rotterdam, Netherlands
Larner College of Medicine, University of Vermont, Burlington, VT, United States
Cardiovascular Department, King Fahd Armed Forces Hospital, Makkah, Jeddah, Saudi Arabia
Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom

Department of Cardiology and Interventional Arrhythmology
Rentgen-endovascular Laboratory
Department of Cardiology
Department of Cardiology
Larner College of Medicine
Cardiovascular Department
Keele Cardiovascular Research Group

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