Impact of In-Hospital Acquired Thrombocytopenia in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

• Published in: The American journal of cardiology Vol. 96; no. 4; pp. 474 - 481
• Main Authors: Nikolsky, Eugenia, Sadeghi, H. Mehrdad, Effron, Mark B., Mehran, Roxana, Lansky, Alexandra J., Na, Yingbo, Cox, David A., Garcia, Eulogio, Tcheng, James E., Griffin, John J., Stuckey, Thomas D., Turco, Mark, Carroll, John D., Grines, Cindy L., Stone, Gregg W.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.08.2005; Elsevier
• Subjects: Age Distribution; Aged; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - methods; Antibodies, Monoclonal - adverse effects; Biological and medical sciences; Cardiology. Vascular system; Cause of Death - trends; Coronary heart disease; Female; Follow-Up Studies; General aspects; Heart; Hematologic and hematopoietic diseases; Hemorrhage - blood; Hemorrhage - epidemiology; Hemorrhage - etiology; Human infectious diseases. Experimental studies and models; Humans; Immunoglobulin Fab Fragments - adverse effects; Incidence; Infectious diseases; Inpatients; Male; Medical sciences; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Odds Ratio; Platelet Aggregation Inhibitors - adverse effects; Platelet Count; Platelet diseases and coagulopathies; Prospective Studies; Risk Factors; Sex Distribution; Survival Rate; Thrombocytopenia - epidemiology; Thrombocytopenia - etiology; Treatment Outcome; Human; Myocardial infarction; Thrombocytopenia; Nosocomial infection; Angioplasty; Acute; Instrumentation therapy; Cardiovascular disease; Hemopathy; Instrumental dilatation; Myocardial disease; Phlebology; Platelet; Heart disease; Primary; Circulatory system; Cardiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2005.04.005

Thrombocytopenia that develops after percutaneous coronary intervention (PCI) may result in hemorrhagic complications, requirement for blood product transfusions, and potentially thrombotic or ischemic complications. The incidence and prognostic significance of thrombocytopenia, in patients with acute myocardial infarction (AMI) who undergo primary PCI have not been evaluated. In the CADILLAC trial 2,082 patients who had AMI within 12 hours of onset without shock were prospectively randomized to receive balloon angioplasty with or without abciximab versus stenting with or without abciximab. Acquired thrombocytopenia, defined as a nadir platelet count <100 × 10 9/L in patients who did not have baseline thrombocytopenia, developed in 50 of 1,975 qualifying patients (2.5%) after primary PCI. By multivariate analysis, acquired thrombocytopenia developed more frequently in patients who had non-insulin-requiring diabetes mellitus (odds ratio 3.88 [OR], p = 0.0002), previous statin administration (OR 3.28, p = 0.002), and use of abciximab (OR 2.06, p = 0.02) and less frequently in patients who had previous aspirin use (OR 0.26, p = 0.002), a higher baseline platelet count (OR 1.20, p < 0.0001), and greater body mass index (OR 0.90, p = 0.006). Patients who developed thrombocytopenia versus those who did not had higher in-hospital rates of major hemorrhagic complications (10.0% vs 2.7%, p = 0.01), greater requirement for blood transfusions (10.0% vs 3.9%, p = 0.05), longer hospital stay (median 4.8 vs 3.6 days, p = 0.008), and increased costs (median $14,466 vs $11,629, p = 0.001). All-cause mortality was markedly increased at 30 days (8.0% vs 1.6%, p = 0.0008) and at 1 year (10.0% vs 3.9%, p = 0.03) in patients who developed thrombocytopenia. In conclusion, thrombocytopenia that develops after primary PCI for AMI, although uncommon, is associated with increased hemorrhagic complications and decreased survival.