Dynamic platelet trajectory patterns and their nonlinear association with mortality in acute myocardial infarction

Q: What are the key findings of this study?

Ascending platelet trajectories during the first 4 days of ICU admission were associated with a significantly lower 28-day mortality risk compared to descending patterns (OR 0.42) in patients with acute myocardial infarction.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (n=3657). Intervention: Ascending platelet trajectory vs. Descending platelet trajectory. Primary outcome: 28-day all-cause mortality (OR 0.42, 95% CI 0.33-0.54, p=<0.001).

Q: What does this research mean for the field?

Ascending and stable platelet trajectories during the first 4 days of ICU admission are associated with significantly lower 28-day mortality compared to descending trajectories in patients with acute myocardial infarction. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To identify distinct platelet trajectory patterns during early intensive care unit admission and assess their association with 28-day mortality in patients with acute myocardial infarction.

Bing Zeng; Zhenguo Luo; Shouqiang Zhu; Gang Wu; Qiankun Yang

doi:10.1038/s41598-026-60506-w

July 6, 2026Scientific ReportsOpen Access

Dynamic platelet trajectory patterns and their nonlinear association with mortality in acute myocardial infarction

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Key result

Ascending platelet trajectories link to ~58% lower 28-day mortality in post-MI ICU patients.

OR 0.42
95% CI 0.33-0.54
P<0.001
n=3,657

Why the study?

While platelet counts are known prognostic markers in AMI, the predictive value of dynamic platelet trajectories and their nonlinear association with nadir platelet counts remains unexplored.

Do ascending or stable platelet trajectories improve 28-day mortality compared to descending trajectories in patients with acute myocardial infarction?

Key Points

To identify distinct platelet trajectory patterns during early intensive care unit admission and assess their association with 28-day mortality in patients with acute myocardial infarction.
Retrospective cohort analysis of 3,657 patients with acute myocardial infarction from the MIMIC-IV database with platelet counts tracked over the first 4 days of ICU admission.
Unsupervised factor analysis and k-means clustering based on 24 dynamic summary metrics classified patients into ascending (n = 860), stable (n = 2,270), and descending (n = 527) trajectory groups.
Associations with 28-day mortality were evaluated using multivariable logistic regression, inverse probability weighting, doubly robust estimation, and restricted cubic splines.
Ascending (OR = 0.42, 95% CI 0.33–0.54, p < 0.001) and stable trajectories (OR = 0.48, 95% CI 0.39–0.59, p < 0.001) showed significantly lower 28-day mortality compared to the descending group; 28-day survival rates were 87.7% for ascending, 85.7% for stable, and 71.9% for descending trajectories (log-rank p < 0.0001).
Doubly robust models confirmed lower 28-day mortality odds in the ascending (OR = 0.43, 95% CI 0.33–0.56, p < 0.001) and stable groups (OR = 0.49, 95% CI 0.39–0.62, p < 0.001) relative to the descending group.
Nadir platelet counts exhibited a significant J-shaped association with 28-day mortality (P-nonlinear < 0.001), with the lowest estimated risk occurring at approximately 168 × 10⁹/L.

Study Design

Type

Cohort (n=3,657)

Multicenter

No

Structured PICO

Do ascending or stable platelet trajectories improve 28-day mortality compared to descending trajectories in patients with acute myocardial infarction?

P

Population

3,657 adult patients (median age 65, 42% female) with acute myocardial infarction admitted to the ICU, with at least two platelet measurements in the first 96 hours, followed for 28 days.

E

Exposure

Ascending (AS, n=860) or stable (ST, n=2,270) platelet trajectory patterns during the first 4 days (96 hours) of ICU admission

C

Comparator

Descending (DS, n=527) platelet trajectory pattern during the first 4 days (96 hours) of ICU admission

O

Outcome

28-day all-cause mortalityhard clinical

Main Result

Odds Ratio: 0.42 (95% CI 0.33–0.54)

Absolute Event Rate: 12.3% vs 28.1%

p-value: p=<0.001

In critically ill patients with acute myocardial infarction, ascending or stable platelet trajectories during the first 4 days of ICU admission are associated with significantly lower 28-day mortality compared to descending trajectories.

Limitations

Observational design precludes causal inferences
Single-center nature of the MIMIC-IV database limits generalizability to other healthcare systems and non-ICU cohorts
Trajectory analysis was limited to the early ICU period (first 96 hours), leaving longer-term patterns unexplored
No formal subgroup or interaction analyses were performed according to AMI subtype (STEMI vs NSTEMI)
Potential residual confounding from unmeasured factors such as the timing and intensity of antithrombotic therapies
Observational nature limits causal inference regarding biological mechanisms
Nadir platelet thresholds identified are exploratory markers for early risk stratification rather than definitive therapeutic targets

Implication

Supports platelet trajectory monitoring for AMI prognostication; hypothesis-generating and warrants prospective validation before practice change.

Abstract

While platelet counts are known prognostic markers in acute myocardial infarction (AMI), the predictive value of dynamic platelet trajectories and their nonlinear association with nadir platelet counts remains unexplored. We aimed to identify distinct platelet trajectory patterns and evaluate their independent association with 28-day mortality in AMI patients. Using the MIMIC-IV database, we analyzed longitudinal platelet counts during the first 4 days of ICU admission in 3,657 AMI patients, Platelet trajectory patterns were identified using an unsupervised clustering approach combining factor analysis and k-means clustering based on 24 predefined summary measures describing temporal platelet dynamics. Patients were classified into ascending (AS), stable (ST), and descending (DS) trajectory groups. Associations with 28-day mortality were assessed using multivariate logistic regression, inverse probability weighting (IPW), and doubly robust estimation, with the DS group as the reference. Restricted cubic spline analysis was used to evaluate nonlinear relationships between nadir platelet counts and mortality. The cohort (median age 65 years; 58% male) revealed three distinct platelet trajectories: ascending (AS, n = 860), stable (ST, n = 2,270), and descending (DS, n = 527). Compared to the high-risk DS group, both AS (OR = 0.42, 95% CI 0.33–0.54) and ST (OR = 0.48, 95% CI 0.39–0.59) groups showed significantly lower 28-day mortality (all p < 0.001), with consistent results in IPW (AS: OR = 0.45; ST: OR = 0.51) and doubly robust models (AS: OR = 0.43; ST: OR = 0.49). Nadir platelet counts demonstrated a significant J-shaped association with mortality ( P -nonlinear < 0.001), with the lowest estimated mortality risk observed at approximately 168 × 10⁹/L. Ascending/stable platelet trajectories are associated with reduced mortality risk compared to descending patterns in AMI, while extreme nadir values independently predict poor outcomes. Dynamic monitoring of platelet trajectories and nadir platelet levels may provide additional prognostic information for early risk stratification in AMI patients.

Discussion

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Cite This Study

Zeng et al. (2026) conducted a cohort in Acute myocardial infarction (n=3,657). Ascending platelet trajectory vs. Descending platelet trajectory was evaluated on 28-day all-cause mortality (OR 0.42, 95% CI 0.33-0.54, p=<0.001). Ascending platelet trajectories during the first 4 days of ICU admission were associated with a significantly lower 28-day mortality risk compared to descending patterns (OR 0.42) in patients with acute myocardial infarction.

synapsesocial.com/papers/6a4de976d2ea289ef6283a72 https://doi.org/10.1038/s41598-026-60506-w

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Dynamic platelet trajectory patterns and their nonlinear association with mortality in acute myocardial infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Dynamic platelet trajectory patterns and their nonlinear association with mortality in acute myocardial infarction

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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