Low baseline platelet counts (<175x10^9/L) were associated with major bleeding (HR 1.51; 95% CI 1.15-2.00), while high counts (>250x10^9/L) were linked to MACE (HR 1.47; 95% CI 1.22-1.78) after PCI.
Meta-Analysis (n=217,459)
Does baseline platelet count predict all-cause mortality, MACE, and major bleeding in patients undergoing PCI?
Baseline platelet count exhibits a J-shaped relationship with clinical outcomes after PCI, where low counts predict bleeding and high counts predict ischemic events.
Hazard Ratio: 1.39 (95% CI 1.3–1.49)
Objectives The nature of the relationship between baseline platelet count and clinical outcomes following percutaneous coronary intervention (PCI) is unclear. We undertook dose–response and pairwise meta-analyses to better describe the prognostic value of the initial platelet count and clinical endpoints in patients after PCI. Methods A search of PubMed, Scopus and Web of Science (up to 9 October 2021) was performed to identify studies that evaluated the association between platelet count and clinical outcomes following PCI. The primary outcomes of interest were all-cause mortality, major adverse cardiovascular events (MACE) and major bleeding. We performed random-effects pairwise and one-stage dose–response meta-analyses by calculating HRs and 95% CIs. Results The meta-analysis included 19 studies with 217 459 patients. We report a J-shaped relationship between baseline thrombocyte counts and all-cause death, MACE and major bleeding at follow-up. The risk of haemorrhagic events exceeded the risk of thrombotic events at low platelet counts (250×10 9 /L). Pairwise meta-analyses revealed a robust link between initial platelet counts and the risk of postdischarge all-cause mortality, major bleeding (for thrombocytopenia: HR 1.39, 95% CI 1.30 to 1.49; HR 1.51, 95% CI 1.15 to 2.00, respectively) and future death from any cause and MACE (thrombocytosis: HR 1.60, 95% CI 1.29 to 1.98; HR 1.47, 95% CI 1.22 to 1.78, respectively). Conclusion Low platelet counts were associated with the predominant bleeding risk, while high platelet counts were only associated with the ischaemic events. PROSPERO registration number CRD42021283270.
Galimzhanov et al. (Wed,) conducted a meta-analysis in percutaneous coronary intervention (PCI) (n=217,459). Baseline platelet count was evaluated on all-cause mortality (associated with thrombocytopenia) (HR 1.39, 95% CI 1.30-1.49). Low baseline platelet counts (<175x10^9/L) were associated with major bleeding (HR 1.51; 95% CI 1.15-2.00), while high counts (>250x10^9/L) were linked to MACE (HR 1.47; 95% CI 1.22-1.78) after PCI.