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Ahsan MJ, Lateef N, Latif A, Malik SU, Batool SS, Fazeel HM, Ahsan MZ, Faizi Z, Thandra A, Mirza M, Kabach A, Core MD. A systematic review and meta-analysis of impact of baseline thrombocytopenia on cardiovascular outcomes and mortality in patients undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2021; 97:E778-E788. [PMID: 33232562 DOI: 10.1002/ccd.29405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/04/2020] [Accepted: 11/14/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Thrombocytopenia (TP) is associated with higher incidence of bleeding in the setting of percutaneous coronary intervention (PCI) leading to increased morbidity and mortality. Herein, we report a meta-analysis evaluating the effects of baseline thrombocytopenia (bTP) on cardiovascular outcomes in patients undergoing PCI. METHODS Literature search was performed using PubMed, Embase, Cochrane library and clinicaltrials.gov from inception till October 2019. Patients were divided into two groups: Patients with (a) no Thrombocytopenia (nTP) (b) bTP before PCI. Primary endpoints were in-hospital, and all-cause mortality rates at the longest follow-up. The main summary estimate was random effects risk ratio (RR) with 95% confidence intervals (CIs). RESULTS A total of 6,51,543 patients from 10 retrospective studies were included. There was increased in-hospital all-cause mortality (RR 2.58 [1.7-3.8], p < .001) and bleeding (RR 2.37 [1.41-3.98], p < .005), in the bTP group compared to the nTP group. There was no difference for in-hopsital major adverse cardiovascular outcomes (MACE) (RR 1.38 [0.94-2.0], p < .10), post-PCI MI (RR 1.17 [0.9-1.5], p = .19) and TVR (RR 1.65 [0.8-3.6], p = .21), respectively. Outcomes at longest follow-up showed increased incidence of all-cause mortality (RR 1.86 [1.2-2.9], p < .006) and bleeding (RR 1.72 [1.1-2.9], p = .04) in bTP group, while there was no significant difference for post-PCI MI (RR 1.07 [0.91-1.3], p = .42), MACE (RR 1.86 [0.69-1.8], p = .68) and TVR (RR 1.1 [0.9-1.2], p = .93) between both groups. CONCLUSIONS bTP in patients undergoing PCI is associated with increased mortality and predicts risk of bleeding.
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Affiliation(s)
- Muhammad J Ahsan
- Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Noman Lateef
- Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Azka Latif
- Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Saad U Malik
- Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
| | - Syeda S Batool
- Department of Internal Medicine, University of Alabama, Huntsville, Alabama, USA
| | - Hafiz M Fazeel
- Department of Internal Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Mohammad Z Ahsan
- Department of Internal Medicine, Fatima Memorial Hospital, Lahore, Pakistan
| | - Zaheer Faizi
- Department of Surgery, Crozer Chester Medical Center, Upland, Pennsylvania, USA
| | - Abhishek Thandra
- Division of Cardiovascular Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Mohsin Mirza
- Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Amjad Kabach
- Division of Cardiovascular Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Michael Del Core
- Division of Cardiovascular Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
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Ahsan MJ, Fazeel HM, Haque SMU, Malik SU, Latif A, Lateef N, Batool SS, Kousa O, Ahsan MZ, Anwer F, Andukuri V, Smer A. Impact of Acquired Thrombocytopenia on Cardiovascular Outcomes in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 27:79-87. [PMID: 32800731 DOI: 10.1016/j.carrev.2020.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acquired thrombocytopenia (aTP) is associated with a high frequency of bleeding and ischemic complications in patients undergoing percutaneous coronary intervention (PCI). Herein, we report a meta-analysis evaluating the adverse effects of aTP on cardiovascular outcomes and mortality post-PCI. METHODS A literature search was performed using PubMed, Embase, Cochrane and, clinicaltrials.gov from the inception of these databases through October 2019. Patients were divided into two groups: 1) No Thrombocytopenia (nTP) and 2) Acquired Thrombocytopenia (aTP) after PCI. Primary endpoints were in-hospital, 30-day and all-cause mortality rates at the longest follow-up. The main summary estimate was random effects Risk ratio (RR) with 95% confidence intervals (CIs). RESULTS Seven studies involving 57,247 participants were included. There was significantly increased in-hospital all-cause mortality (HR 10.73 [6.82-16.88]), MACE (HR 2.96 [2.24-3.94]), major bleeding (HR 4.78 [3.54-6.47]), and target vessel revascularization (TVR) (HR 7.53 [2.8-20.2]), in the aTP group compared to the nTP group. Similarly, aTP group had a statistically significant increased incidence of 30-day all-cause mortality (HR 6.08), MACE (HR 2.77), post-PCI MI (HR 1.98), TVR (HR 5.2), and major bleeding (HR 12.73). Outcomes at longest follow-up showed increased incidence of all-cause mortality (HR 3.98 [1.53-10.33]) and MACE (HR 1.24 [0.99-1.54]) in aTP group, while there was no significant difference for post-PCI MI (HR 0.94 [0.37-2.39]) and TVR (HR 0.96 [0.69-1.32]) between both groups. CONCLUSIONS Acquired Thrombocytopenia after PCI is associated with increased morbidity, mortality, adverse bleeding events and the need for in-hospital and 30-day TVR.
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Affiliation(s)
- Muhammad Junaid Ahsan
- Department of Internal Medicine, Creighton University Medical Center, Omaha, NE, USA.
| | - Hafiz Muhammad Fazeel
- Department of Internal Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Syed Mansur Ul Haque
- Department of Internal Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - Saad Ullah Malik
- Department of Internal Medicine, Marshall University, Huntington, WV, USA
| | - Azka Latif
- Department of Internal Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - Noman Lateef
- Department of Internal Medicine, Creighton University Medical Center, Omaha, NE, USA
| | | | - Omar Kousa
- Department of Internal Medicine, Creighton University Medical Center, Omaha, NE, USA
| | | | - Faiz Anwer
- Department of Hematology/Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Venkata Andukuri
- Department of Internal Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - Aiman Smer
- Division of Cardiovascular Medicine, Creighton University Medical Center, Omaha, NE, USA
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