Author + information
- Received April 4, 2018
- Revision received May 15, 2018
- Accepted May 16, 2018
- Published online September 17, 2018.
- Karam Ayoub, MDa,∗ (, )
- Meera Marji, MDa,
- Gbolahan Ogunbayo, MDa,
- Ahmad Masri, MDb,
- Ahmed Abdel-Latif, MDa,
- Khaled Ziada, MDa and
- Srikanth Vallurupalli, MDc,d
- aDivision of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky
- bDivision of Cardiovascular Diseases, UPMC-Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
- cDivision of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- dDivision of Cardiovascular Medicine, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
- ↵∗Address for correspondence:
Dr. Karam Ayoub, Division of Internal Medicine, University of Kentucky, 900 South Limestone Street, CTW 326, Lexington, Kentucky 40536.
Objectives This study sought to evaluate the impact of chronic thrombocytopenia (cTCP) on clinical outcomes after percutaneous coronary intervention (PCI).
Background The impact of cTCP on clinical outcomes after PCI is not well described. Results from single-center observational studies and subgroup analysis of randomized trials have been conflicting and these patients are either excluded or under-represented in randomized controlled trials.
Methods Using the 2012 to 2014 National (Nationwide) Inpatient Sample database, the study identified patients who underwent PCI with or without cTCP as a chronic condition variable indicator. Propensity score matching was performed using logistic regression to control for differences in baseline characteristics. The primary outcome of interest was in-hospital mortality. Secondary outcomes of interest included in-hospital post-PCI bleeding events, post-PCI blood and platelet transfusion, vascular complications, ischemic cerebrovascular accidents (CVAs), hemorrhagic CVAs, and length of stay.
Results Propensity matching yielded a cohort of 65,130 patients (32,565 with and without cTCP). Compared with those without cTCP, PCI in patients with cTCP was associated with higher risk for bleeding complications (odds ratio [OR]: 2.40; 95% confidence interval [CI]: 2.05 to 2.72; p < 0.0001), requiring blood transfusion (OR: 2.10; 95% CI: 1.80 to 2.24; p < 0.0001), requiring platelet transfusion (OR: 11.70; 95% CI: 6.00 to 22.60; p < 0.0001), higher risk for vascular complications (OR: 1.94; 95% CI: 1.43 to 2.63; p < 0.0001), ischemic CVA (OR: 1.60; 95% CI: 1.20 to 2.10; p = 0.01), and higher in-hospital mortality (OR: 2.30; 95% CI: 1.90 to 2.70; p < 0.0001), but without a significant difference in hemorrhagic CVA (OR: 1.50; 95% CI: 0.70 to 3.10; p = 0.27).
Conclusions In this large contemporary cohort, patients with cTCP were at higher risk of a multitude of complications, including higher risk of in-hospital mortality.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 4, 2018.
- Revision received May 15, 2018.
- Accepted May 16, 2018.
- 2018 American College of Cardiology Foundation