Key result
In patients with ACS and elevated platelet counts, PCI was associated with a lower risk of net adverse clinical events compared to non-PCI (OR 0.53; 95% CI 0.37-0.77; P=0.001).
Why the study?
In patients with ACS requiring PCI, abnormally elevated platelet counts are associated with increased risks of stent thrombosis and bleeding, but the clinical benefits of PCI in this group needed exploration.
Does percutaneous coronary intervention reduce net adverse clinical events in patients with acute coronary syndromes and increased platelet counts?
Cohort (n=4,501)
Does percutaneous coronary intervention reduce net adverse clinical events in patients with acute coronary syndromes and increased platelet counts?
Odds Ratio: 0.53 (95% CI 0.37–0.77)
p-value: p=0.001
In patients with acute coronary syndromes and elevated platelet counts, PCI is associated with a significant reduction in ischemic events without a significant increase in major bleeding during the index hospitalization.
May support PCI in ACS with elevated platelets; leaves open causal confirmation in RCTs.
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: /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.
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Zhang et al. (2025) conducted a cohort in Acute coronary syndromes with elevated platelet counts (n=4,501). Percutaneous coronary intervention (PCI) vs. Non-PCI was evaluated on Net adverse clinical events (NACE), including major adverse cardiovascular or cerebrovascular events and major bleeding during the index hospitalization (OR 0.53, 95% CI 0.37-0.77, p=0.001). In patients with ACS and elevated platelet counts, PCI was associated with a lower risk of net adverse clinical events compared to non-PCI (OR 0.53; 95% CI 0.37-0.77; P=0.001).
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