Author + information
- Vanessa Discepola,
- Mireille Schnitzer,
- E. Marc Jolicoeur,
- Guy Rousseau and
- Marie Lordkipanidzé
Background: The aim of this systematic review and meta-analysis was to consider the evidence on the clinical importance of baseline or in-hospital acquired thrombocytopenia (TP) in the context of an acute coronary syndrome (ACS). This was split into two research questions: What is the frequency and associated factors with TP in the context of ACS? What is the effect of TP on mortality, major adverse cardiovascular events (MACE) and bleeding in patients hospitalized for ACS?
Methods: Systematic literature searches were conducted using MEDLINE. For the meta-analysis, we used all available aggregate data in a linear mixed model for each outcome, with random effects for both study and outcome assessment time. Bayesian Information Criterion was used to select a reduction in the complexity of models.
Results: Fourteen studies encompassing 166,361 patients informed the meta-analysis. TP was an uncommon event with a prevalence of 6.9% (SE = 6.9 × 10-3) of patients presenting with low platelet counts at baseline and 6.2% (SE = 1.2 × 10-2) of patients developing TP in-hospital following ACS. When compared to their counterparts, patients with baseline or in-hospital acquired TP were on average older (>65 years), male (69% vs. 65%, P < 0.05) and presented with numerous comorbidities. The pooled analysis revealed a significant difference in risk of adverse clinical outcomes such as all-cause mortality (RD: 0.05; 95% CI: 0.04-0.07; P< 0.05), MACE (RD: 0.09; 95% CI: 0.06-0.13; P< 0.05) and major bleeding (RD: 0.13; 95% CI: 0.04-0.23; P< 0.05) when comparing patients who developed TP following their hospitalization and those who did not. This association persisted in a secondary analysis adjusting for age and sex (P< 0.05). There were no significant differences in the risk of ischemic and bleeding outcomes between patients with baseline TP and those without.
Conclusions: TP occurs infrequently in the setting of ACS and identifies a high-risk patient population more likely to experience ischemic or bleeding complications, as well as higher mortality. Future prospective studies are warranted in order to establish causality between TP and the occurrence adverse cardiac events in patients admitted for an ACS.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Optimizing the Care of ACS Patients
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1284-153
- 2017 American College of Cardiology Foundation