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Blood Platelet Count at Hospital Admission Impacts Long-Term Mortality in Patients with Acute Coronary Syndrome.

入院时血小板计数影响急性冠脉综合征患者的长期死亡率。

  • 影响因子:1.25
  • DOI:10.1159/000505640
  • 作者列表:"Małyszczak A","Łukawska A","Dyląg I","Lis W","Mysiak A","Kuliczkowski W
  • 发表时间:2020-02-04
Abstract

INTRODUCTION:Platelets play a fundamental role in the pathogenesis of acute coronary syndrome (ACS). The platelet count (PC) at hospital admission is easy to obtain, but whether thrombocytopenia or/and thrombocytosis impact long-term mortality (LTM) after ACS is unclear. OBJECTIVE:To evaluate the effect of PC at hospital admission on LTM in patients with ACS. METHODS:This retrospective cohort study included patients with the ICD-10 codes for unstable angina (I.20) and acute myocardial infarction (I.21, I.22). Thrombocytopenia was defined as a blood PC <150 G/L and thrombocytosis as a PC >450 G/L. Additional platelet indices which were tested included plateletcrit (PCT), the mean platelet volume (MPV), the platelet distribution width (PDW), and the platelet larger cell ratio (P-LCR). Data on all-cause death were obtained from the National Health Fund database. RESULTS:The study included 3,162 patients with a median follow-up of 27.2 months (interquartile range 12.5-46.8 months; max 68.7 months). Patients with thrombocytopenia and thrombocytosis yielded a higher maximal analyzed 5-year mortality rate in comparison with normal PC patients (45.8 and 47.7 vs. 24.2%, respectively; p < 0.00001) which was mainly driven by higher deaths at 1-2 years after ACS. The 5-year LTM was also significantly higher in patients with abnormal PCT and MPV levels in comparison with patients with PCT and MPV within the normal range. Other platelet indices (PDW, P-LCR) were not associated with a worse outcome. The Cox proportional hazards model revealed that thrombocytopenia at admission was independently associated with higher LTM after ACS (RR 1.83; 95% CI 1.1-3.0; p = 0.01). CONCLUSIONS:Both thrombocytopenia and thrombocytosis at hospital admission in post-ACS patients are associated with a significant almost two times higher 5-year mortality rate.

摘要

引言: 血小板在急性冠状动脉综合征 (ACS) 的发病机制中起着基础作用。入院时血小板计数 (PC) 很容易获得,但血小板减少或/和血小板增多是否影响 ACS 后的长期死亡率 (LTM) 尚不清楚。 目的: 评价入院时 PC 对 ACS 患者 LTM 的影响。 方法: 本回顾性队列研究包括不稳定型心绞痛 (I.20) 和急性心肌梗死 (I.21,I.22) ICD-10 编码的患者。血小板减少定义为血 PC 450G/L。检测的其他血小板指标包括血小板压积 (PCT) 、平均血小板体积 (MPV) 、血小板分布宽度 (PDW) 和血小板较大细胞比率 (P-LCR)。全因死亡数据来自国家卫生基金数据库。 结果: 研究纳入 3,162 例患者,中位随访时间为 27.2 个月 (四分位距 12.5-46.8 个月; 最大 68.7 个月)。与正常 PC 患者相比,血小板减少和血小板增多患者的最大分析 5 年死亡率较高 (45.8 和 47.7 vs. 分别为 24.2%; p

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发表时间:2020-01-01
DOI:10.1055/s-0039-1700546
作者列表:["Tavenier AH","Hermanides RS","Fabris E","Lapostolle F","Silvain J","Ten Berg JM","Lassen JF","Bolognese L","Cantor WJ","Cequier Á","Chettibi M","Goodman SG","Hammett CJ","Huber K","Janzon M","Merkely B","Storey RF","Zeymer U","Ecollan P","Collet JP","Willems FF","Diallo A","Vicaut E","Hamm CW","Montalescot G","van 't Hof AWJ","ATLANTIC investigators."]

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影响因子:1.21
发表时间:2020-01-01
DOI:10.1097/MCA.0000000000000737
作者列表:["Huang X","Chen S","Redfors B","Zhang Y","Souza CF","Mehran R","Bansilal S","Kirtane AJ","Brener SJ","Feite F","Dangas GD","Ben-Yehuda O","Stone GW"]

METHODS:OBJECTIVES:There are limited data on bivalirudin monotherapy in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) with positive biomarkers of myocardial necrosis (troponin and/or creatine kinase-myocardial band isoenzyme). We sought to evaluate the safety and efficacy of bivalirudin monotherapy in patients with positive biomarkers from the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. PATIENTS AND METHODS:We compared the net adverse clinical events [composite ischemia - (death, myocardial infarction, or unplanned ischemic revascularization) - or noncoronary artery bypass graft surgery (CABG)-related major bleeding] among patients with biomarker-positive NSTE-ACS in the ACUITY trial overall and by antithrombotic strategy. RESULTS:Among 13 819 patients with NSTE-ACS enrolled in ACUITY, 4728 patients presented with positive biomarkers and underwent an early invasive strategy. Of those, 1547 were randomized to heparin plus a glycoprotein IIb/IIIa inhibitor (GPI), 1555 to bivalirudin plus GPI, and 1626 to bivalirudin monotherapy. Compared with biomarker-negative patients, biomarker-positive patients had higher 30-day rates of net adverse clinical events (14.0 vs. 12.4%; P = 0.04), all-cause death (1.3 vs. 0.5%; P = 0.001), cardiac death (1.1 vs. 0.5%; P = 0.005), and non-CABG-related major bleeding (6.5 vs. 5.2%, P = 0.03). At 30 days, bivalirudin monotherapy was associated with significantly less non-CABG-related major bleeding (bivalirudin monotherapy 4.1% vs. bivalirudin plus GPI 8.4% vs. heparin plus GPI 7.1%) with comparable rates of composite ischemia (bivalirudin monotherapy 9.2% vs. bivalirudin plus GPI 9.9% vs. heparin plus GPI 8.4%). In a multivariable model, bivalirudin monotherapy was associated with a significant reduction in non-CABG-related major bleeding but was not associated with an increased risk of death, myocardial infarction, unplanned revascularization or stent thrombosis. CONCLUSION:Compared with heparin plus GPI or bivalirudin plus GPI, bivalirudin monotherapy provides similar protection from ischemic events with less major bleeding at 30 days among patients with NSTE-ACS and positive biomarkers.

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影响因子:2.86
发表时间:2020-01-01
DOI:10.1016/j.amjcard.2019.09.045
作者列表:["Ravi V","Pulipati P","Vij A","Kodumuri V"]

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