What is the clinical evidence from this study?

Study design: Observational. Population: Hemodynamically unstable patients requiring intra-aortic balloon pumping (IABP) (n=439). Intervention: 10% higher percent platelet reduction during IABP. Primary outcome: Cardiovascular mortality after device removal (HR 1.3, 95% CI 1.1-1.6, p=<0.001).

January 16, 2020Open Access

Reduced Number of Platelets During Intra-Aortic Balloon Pumping Counterpulsation Predicts Higher Cardiovascular Mortality After Device Removal in Association with Systemic Inflammation

Q: What are the key findings of this study?

A 10% greater reduction in platelet count during intra-aortic balloon pumping was associated with a significantly increased risk of cardiovascular mortality after device removal (HR 1.3).

Key Result

A 10% greater reduction in platelet count during intra-aortic balloon pumping was associated with a significantly increased risk of cardiovascular mortality after device removal (HR 1.3).

Study Design

Type

Observational (n=439)

Multicenter

Yes

Structured PICO

Does a higher percent reduction in platelets during IABP counterpulsation predict higher cardiovascular mortality after device removal in acutely critical patients?

Population

392 acutely critical patients who were using intra-aortic balloon pumping (IABP) with or without veno-arterial extracorporeal membrane oxygenation (V-A ECMO) during a hemodynamically critical condition (excluding 47 patients who died during IABP use), mean age 70.3, 76.8% male, Japan-based (three hospitals).

Intervention

Higher percent platelet reduction (% PLT reduction > 50% or 10% higher % PLT reduction) during IABP use

Comparator

Lower percent platelet reduction (% PLT reduction ≤ 50%) during IABP use

Outcome

Cardiovascular mortality in the follow-up period after IABP removalhard clinical

A greater reduction in platelet count during IABP counterpulsation independently predicts an increased risk of cardiovascular mortality after device removal, potentially linked to systemic inflammation.

Main Result

Effect estimate: HR 1.3 (95% CI 1.1-1.6)

p-value: p=<0.001

Limitations

Retrospective study design cannot establish causality
Did not primarily investigate hematological or other causes of the reduction in platelet number
Mechanical support devices used were limited to IABP and V-A ECMO

Abstract

Thrombocytopenia is a frequent complication in patients requiring intra-aortic balloon pumping (IABP) counterpulsation. However, its prognostic impact has not been fully addressed. The objective of this study is to evaluate the impact of the change in the platelet number during IABP use on the prognosis after device removal.This is a retrospective observational study. Patients in the intensive cardiac care unit at three Juntendo University hospitals who underwent percutaneous implantation of IABP with or without veno-arterial extracorporeal membrane oxygenation (V-A ECMO), since 2012-2016, were enrolled in the study (n = 439). Patients who died during mechanical circulatory support (n = 47) were excluded. We evaluated the prognostic impact of the ratio of platelet reduction from the baseline (% PLT reduction) during IABP use on cardiovascular mortality after device removal.The median and the range of follow-up period were 298 days and 0-1,869 days, respectively. Unadjusted Kaplan-Meier analysis demonstrated that patients with a higher % PLT reduction had higher cardiovascular (CV) mortality. An adjusted Cox proportional hazard analysis demonstrated that a 10% higher % PLT reduction was associated with higher cardiovascular (CV) mortality (Hazard ratio: 1.3, 95% Confidence interval: 1.1-1.6, P < 0.001). Moreover, % PLT reduction and the maximum C-reactive protein (CRP) level during IABP use were positively correlated (r = 0.326, P < 0.001).The reduced number of platelets during IABP use was associated with an increased risk of CV mortality.

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