Impact of Acquired Thrombocytopenia on Cardiovascular Outcomes in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis
Affiliation:
1. Department of Internal Medicine, Creighton University Medical Center, Omaha, NE, USA;2. Department of Internal Medicine, Services Institute of Medical Sciences, Lahore, Pakistan;3. Department of Internal Medicine, Marshall University, Huntington, WV, USA;4. Department of Internal Medicine, University of Alabama, Huntsville, AL, USA;5. Department of Internal Medicine, Fatima Memorial Hospital, Lahore, Pakistan;6. Department of Hematology/Oncology, Cleveland Clinic, Cleveland, OH, USA;7. Division of Cardiovascular Medicine, Creighton University Medical Center, Omaha, NE, USA;1. Deutsches Herzzentrum München, Technische Universität München, Munich, Germany;2. DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany;3. 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany;4. Cardiac Department, Hospital Universitario de La Princesa Madrid, Madrid, Spain;1. Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York;2. National Heart and Lung Institute, Imperial College London, London, United Kingdom;3. The Cardiovascular Research Foundation, New York, New York;4. Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York;1. Department of Cardiovascular Medicine, University of Toledo, Ohio;2. Department of Medicine, University of Toledo, Ohio;3. Department of Medicine, Mercy Health St. Vincent Medical Center, Toledo, Ohio;1. Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan;2. Department of Internal medicine, Mutah University, Al-Karak, Jordan;3. Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia;4. Division of cardiology, Hurley Medical Center/Michigan State University, Flint, Michigan;5. Brigham and Women''s Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
Abstract:
BackgroundAcquired thrombocytopenia (aTP) is associated with a high frequency of bleeding and ischemic complications in patients undergoing percutaneous coronary intervention (PCI). Herein, we report a meta-analysis evaluating the adverse effects of aTP on cardiovascular outcomes and mortality post-PCI.MethodsA literature search was performed using PubMed, Embase, Cochrane and, clinicaltrials.gov from the inception of these databases through October 2019. Patients were divided into two groups: 1) No Thrombocytopenia (nTP) and 2) Acquired Thrombocytopenia (aTP) after PCI. Primary endpoints were in-hospital, 30-day and all-cause mortality rates at the longest follow-up. The main summary estimate was random effects Risk ratio (RR) with 95% confidence intervals (CIs).ResultsSeven studies involving 57,247 participants were included. There was significantly increased in-hospital all-cause mortality (HR 10.73 [6.82–16.88]), MACE (HR 2.96 [2.24–3.94]), major bleeding (HR 4.78 [3.54–6.47]), and target vessel revascularization (TVR) (HR 7.53 [2.8–20.2]), in the aTP group compared to the nTP group. Similarly, aTP group had a statistically significant increased incidence of 30-day all-cause mortality (HR 6.08), MACE (HR 2.77), post-PCI MI (HR 1.98), TVR (HR 5.2), and major bleeding (HR 12.73). Outcomes at longest follow-up showed increased incidence of all-cause mortality (HR 3.98 [1.53–10.33]) and MACE (HR 1.24 [0.99–1.54]) in aTP group, while there was no significant difference for post-PCI MI (HR 0.94 [0.37–2.39]) and TVR (HR 0.96 [0.69–1.32]) between both groups.ConclusionsAcquired Thrombocytopenia after PCI is associated with increased morbidity, mortality, adverse bleeding events and the need for in-hospital and 30-day TVR.
