Percutaneous coronary intervention in patients with acute coronary syndromes and increased platelet count

Abstract

Background

In patients with acute coronary syndromes (ACS) requiring percutaneous coronary intervention (PCI), abnormally elevated platelet counts are often associated with an increased risk of stent thrombosis and bleeding.

Aims

To explore the associations between clinical benefits and PCI in patients with ACS and elevated platelet counts.

Methods

Between July 2017 and December 2019, 50,009 patients with ACS were enrolled in the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome Project. This study included patients with platelet count ≥ 300 × 10⁹/L. The primary outcome was net adverse clinical events (NACE), including major adverse cardiovascular or cerebrovascular events (MACCE; all-cause death, myocardial infarction, ischaemic stroke and stent thrombosis) and major bleeding during the index hospitalization. The difference in the risk of NACE between PCI and non-PCI groups was analysed using multivariable analysis and inverse probability of treatment weighting.

Results

Among 4501 patients, PCI rates decreased as platelet count increased, with 3029 patients ultimately undergoing PCI. These patients exhibited a lower rate of NACE (adjusted odds ratio [OR]: 0.53, 95% confidence interval [95% CI]: 0.37–0.77; P = 0.001) and a reduced risk of MACCE (OR: 0.44, 95% CI: 0.29–0.67; P < 0.001). No significant differences in major bleeding were observed (adjusted OR: 1.40, 95% CI: 0.62–3.16; P = 0.417). Inverse probability of treatment weighting confirmed these findings.

Conclusion

In patients with ACS and increased platelet counts who have more complex thrombohaemorrhagic profiles, PCI can effectively reduce the risk of ischaemic events without increasing the risk of bleeding.

Clinical Trial Registration

https://clinicaltrials.gov/study/NCT02306616.