A systematic review and meta-analysis of impact of baseline thrombocytopenia on cardiovascular outcomes and mortality in patients undergoing percutaneous coronary intervention
Corresponding Author
Muhammad J. Ahsan MD
Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
Correspondence
Muhammad J. Ahsan, Chief Medical Resident, Department of Internal Medicine, Creighton University Medical Center, 7500 Mercy road, Omaha, Nebraska 68124, USA.
Email: [email protected]
Search for more papers by this authorNoman Lateef MD
Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
Search for more papers by this authorAzka Latif MD
Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
Search for more papers by this authorSaad U. Malik MD
Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
Search for more papers by this authorSyeda S. Batool MD
Department of Internal Medicine, University of Alabama, Huntsville, Alabama, USA
Search for more papers by this authorHafiz M. Fazeel MD
Department of Internal Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
Search for more papers by this authorMohammad Z. Ahsan MBBS
Department of Internal Medicine, Fatima Memorial Hospital, Lahore, Pakistan
Search for more papers by this authorZaheer Faizi MD
Department of Surgery, Crozer Chester Medical Center, Upland, Pennsylvania, USA
Search for more papers by this authorAbhishek Thandra MD
Division of Cardiovascular Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
Search for more papers by this authorMohsin Mirza MBBS
Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
Search for more papers by this authorAmjad Kabach MD, FACC
Division of Cardiovascular Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
Search for more papers by this authorMichael Del Core MD, FACC
Division of Cardiovascular Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
Search for more papers by this authorCorresponding Author
Muhammad J. Ahsan MD
Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
Correspondence
Muhammad J. Ahsan, Chief Medical Resident, Department of Internal Medicine, Creighton University Medical Center, 7500 Mercy road, Omaha, Nebraska 68124, USA.
Email: [email protected]
Search for more papers by this authorNoman Lateef MD
Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
Search for more papers by this authorAzka Latif MD
Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
Search for more papers by this authorSaad U. Malik MD
Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
Search for more papers by this authorSyeda S. Batool MD
Department of Internal Medicine, University of Alabama, Huntsville, Alabama, USA
Search for more papers by this authorHafiz M. Fazeel MD
Department of Internal Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
Search for more papers by this authorMohammad Z. Ahsan MBBS
Department of Internal Medicine, Fatima Memorial Hospital, Lahore, Pakistan
Search for more papers by this authorZaheer Faizi MD
Department of Surgery, Crozer Chester Medical Center, Upland, Pennsylvania, USA
Search for more papers by this authorAbhishek Thandra MD
Division of Cardiovascular Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
Search for more papers by this authorMohsin Mirza MBBS
Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
Search for more papers by this authorAmjad Kabach MD, FACC
Division of Cardiovascular Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
Search for more papers by this authorMichael Del Core MD, FACC
Division of Cardiovascular Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
Search for more papers by this authorAbstract
Background
Thrombocytopenia (TP) is associated with higher incidence of bleeding in the setting of percutaneous coronary intervention (PCI) leading to increased morbidity and mortality. Herein, we report a meta-analysis evaluating the effects of baseline thrombocytopenia (bTP) on cardiovascular outcomes in patients undergoing PCI.
Methods
Literature search was performed using PubMed, Embase, Cochrane library and clinicaltrials.gov from inception till October 2019. Patients were divided into two groups: Patients with (a) no Thrombocytopenia (nTP) (b) bTP before PCI. Primary endpoints were in-hospital, 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).
Results
A total of 6,51,543 patients from 10 retrospective studies were included. There was increased in-hospital all-cause mortality (RR 2.58 [1.7–3.8], p < .001) and bleeding (RR 2.37 [1.41–3.98], p < .005), in the bTP group compared to the nTP group. There was no difference for in-hopsital major adverse cardiovascular outcomes (MACE) (RR 1.38 [0.94–2.0], p < .10), post-PCI MI (RR 1.17 [0.9–1.5], p = .19) and TVR (RR 1.65 [0.8–3.6], p = .21), respectively. Outcomes at longest follow-up showed increased incidence of all-cause mortality (RR 1.86 [1.2–2.9], p < .006) and bleeding (RR 1.72 [1.1–2.9], p = .04) in bTP group, while there was no significant difference for post-PCI MI (RR 1.07 [0.91–1.3], p = .42), MACE (RR 1.86 [0.69–1.8], p = .68) and TVR (RR 1.1 [0.9–1.2], p = .93) between both groups.
Conclusions
bTP in patients undergoing PCI is associated with increased mortality and predicts risk of bleeding.
CONFLICT OF INTEREST
The authors declare no potential conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study is openly available. All data was driven from the 10 studies included for the analysis.
Supporting Information
| Filename | Description |
|---|---|
| ccd29405-sup-0001-Figure 1.tiffTIFF image, 376.1 KB | Supplementary Figure 1 Forest Plot for Impact of Baseline Thrombocytopenia on In-Hospital outcomes in patients Undergoing PCI. (E) Target Vessel Revascularization, (F) Rate of Blood Transfusion. |
| ccd29405-sup-0002-Figure 2.tiffTIFF image, 373.5 KB | Supplementary Figure 2 Forest Plot for Impact of Baseline Thrombocytopenia on In-Hospital outcomes in patients Undergoing PCI. (E) Stent Thrombosis, (F) Target Vessel Revascularization. |
| ccd29405-sup-0003-supinfo.docxWord 2007 document , 15.7 KB | Supplementary Material: Quality Assessment of the studies included. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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