Low platelet count at admission has an adverse impact on outcome in patients with acute coronary syndromes: from the START Antiplatelet registry.

Autor: Gresele P; Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Strada Vicinale Via Delle Corse, S. Andrea Delle Fratte, 06132, Perugia, Italy. paolo.gresele@unipg.it., Guglielmini G; Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Strada Vicinale Via Delle Corse, S. Andrea Delle Fratte, 06132, Perugia, Italy., Del Pinto M; Division of Cardiology, Perugia Hospital, Perugia, Italy., Calabrò P; Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy., Pignatelli P; Department of Clinical, Internistic, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy., Patti G; Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy., Pengo V; Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy., Antonucci E; Arianna Anticoagulazione Foundation, Bologna, Italy., Cirillo P; Division of Cardiology, Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy., Fierro T; Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Strada Vicinale Via Delle Corse, S. Andrea Delle Fratte, 06132, Perugia, Italy., Palareti G; Arianna Anticoagulazione Foundation, Bologna, Italy., Marcucci R; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2024 Jun 24; Vol. 14 (1), pp. 14516. Date of Electronic Publication: 2024 Jun 24.
DOI: 10.1038/s41598-024-64113-5
Abstrakt: Some previous observations suggest that a low platelet count is associated with an increased risk of adverse outcomes in patients with acute coronary syndromes (ACS). However, most of the data come from post-hoc analyses of randomized controlled trials and from studies including thrombocytopenia developed during hospital stay. Our aim was to assess the impact of low platelet count at admission on cardiovascular outcomes and treatment approach in patients hospitalized for ACS in a current real-life setting in Italy. Patients admitted to Italian coronary care units for ACS were enrolled in the START-ANTIPLATELET registry. Baseline clinical characteristics and treatment at discharge were recorded. Patients were followed-up at 6 months, 1 year and yearly thereafter. Low platelet count was defined as a count at admission < 150 > 100 k/µl or < 100 k/µL. Among 1894 enrolled patients, 157 (8.3%) had a platelet count < 150 > 100 k/µl and 30 (1.6%) < 100 k/µl. The median follow-up was 12.3 months (0.4-50.1). patients with low platelets were older (72 ± 10.4 vs 66 ± 12.4 years, p = 0.006), more frequently males (82.9 vs 72.1%, p = 0.001), hypertensive (90.0% vs 70.4%, p = 0.03), with non-valvular atrial fibrillation (NVAF) (17.1 vs 8.6%, p = 0.02), and peripheral arterial disease (11.5 vs 6.2% p = 0.01) and/or had a previous myocardial infarction (40 vs 18.7%, p = 0.008) and/or a PCI (14.6 vs 7.8%, p = 0.001) than patients with normal platelets. A slightly, but significantly, lower percentage of thrombocytopenic patients were treated with primary PCI (78.1 vs 84.4%, p = 0.04) and they were more frequently discharged on aspirin plus clopidogrel rather than aspirin plus newer P2Y 12 antagonists (51.9 vs 65.4%, p = 0.01). MACE-free survival was significantly shorter in thrombocytopenic patients compared to patients with normal platelets (< 150 > 100 k/µl: 37.6 vs 41.8 months, p = 0.002; HR = 2.7, 95% CIs 1.4-5.2; < 100 k/µl: 31.7 vs 41.8 months, p = 0.01; HR = 6.5, 95% CIs 1.5-29.1). At multivariate analysis, low platelet count, age at enrollment, low glomerular filtration rate, low ejection fraction, a previous ischemic stroke and NVAF were independent predictors of MACE. A low platelet count at admission identifies a subgroup of ACS patients with a significantly increased risk of MACE and these patients should be managed with special care to prevent excess adverse outcomes.
(© 2024. The Author(s).)
Databáze: MEDLINE
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