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Abstract：
Some previous observations suggest that a low platelet count is associated with an increased risk of adverse outcomes in patients with acute coronary syndromes (ACS). However, most of the data come from post-hoc analyses of randomized controlled trials and from studies including thrombocytopenia developed during hospital stay. Our aim was to assess the impact of low platelet count at admission on cardiovascular outcomes and treatment approach in patients hospitalized for ACS in a current real-life setting in Italy. Patients admitted to Italian coronary care units for ACS were enrolled in the START-ANTIPLATELET registry. Baseline clinical characteristics and treatment at discharge were recorded. Patients were followed-up at 6 months, 1 year and yearly thereafter. Low platelet count was defined as a count at admission < 150 > 100 k/µl or < 100 k/µL. Among 1894 enrolled patients, 157 (8.3%) had a platelet count < 150 > 100 k/µl and 30 (1.6%) < 100 k/µl. The median follow-up was 12.3 months (0.4-50.1). patients with low platelets were older (72 ± 10.4 vs 66 ± 12.4 years, p = 0.006), more frequently males (82.9 vs 72.1%, p = 0.001), hypertensive (90.0% vs 70.4%, p = 0.03), with non-valvular atrial fibrillation (NVAF) (17.1 vs 8.6%, p = 0.02), and peripheral arterial disease (11.5 vs 6.2% p = 0.01) and/or had a previous myocardial infarction (40 vs 18.7%, p = 0.008) and/or a PCI (14.6 vs 7.8%, p = 0.001) than patients with normal platelets. A slightly, but significantly, lower percentage of thrombocytopenic patients were treated with primary PCI (78.1 vs 84.4%, p = 0.04) and they were more frequently discharged on aspirin plus clopidogrel rather than aspirin plus newer P2Y12 antagonists (51.9 vs 65.4%, p = 0.01). MACE-free survival was significantly shorter in thrombocytopenic patients compared to patients with normal platelets (< 150 > 100 k/µl: 37.6 vs 41.8 months, p = 0.002; HR = 2.7, 95% CIs 1.4-5.2; < 100 k/µl: 31.7 vs 41.8 months, p = 0.01; HR = 6.5, 95% CIs 1.5-29.1). At multivariate analysis, low platelet count, age at enrollment, low glomerular filtration rate, low ejection fraction, a previous ischemic stroke and NVAF were independent predictors of MACE. A low platelet count at admission identifies a subgroup of ACS patients with a significantly increased risk of MACE and these patients should be managed with special care to prevent excess adverse outcomes.
摘要：
先前的一些观察表明，血小板计数低与急性冠状动脉综合征（ACS）患者的不良结局风险增加有关。然而,大部分数据来自随机对照试验的事后分析,以及包括住院期间发生的血小板减少症在内的研究.我们的目的是评估在意大利目前的现实生活中，入院时血小板计数低对ACS住院患者心血管结局和治疗方法的影响。在START-ANTIPLATELET注册登记中纳入了意大利冠心病监护病房的ACS患者。记录基线临床特征和出院时的治疗情况。随访6个月,一年，此后每年。低血小板计数定义为入院时的计数<150>100k/µL或<100k/µL。在1894名登记的患者中，157（8.3％）的血小板计数<150>100k/μl和30（1.6％）<100k/μl。中位随访时间为12.3个月(0.4-50.1)。低血小板患者年龄较大（72±10.4vs66±12.4岁，p=0.006),更常见的是男性(82.9%vs72.1%，p=0.001),高血压（90.0%vs70.4%，p=0.03),非瓣膜性心房颤动（NVAF）（17.1vs8.6%，p=0.02),和外周动脉疾病（11.5vs6.2％p=0.01）和/或先前有心肌梗死（40vs18.7％，p=0.008)和/或PCI(14.6vs7.8%，p=0.001）比血小板正常的患者。稍微，但重要的是，血小板减少症患者接受直接PCI治疗的比例较低(78.1vs84.4%,p=0.04），他们更频繁地使用阿司匹林加氯吡格雷而不是阿司匹林加新的P2Y12拮抗剂（51.9vs65.4％，p=0.01)。与血小板正常的患者相比，血小板减少症患者的无MACE生存期明显缩短（<150>100k/µl：37.6vs41.8个月，p=0.002；HR=2.7，95%CI=1.4-5.2；<100k/µl：31.7vs41.8个月，p=0.01；HR=6.5，95%CI=1.5-29.1）。在多变量分析中，血小板计数低,入学年龄，肾小球滤过率低，射血分数低,既往缺血性卒中和NVAF是MACE的独立预测因子.入院时血小板计数低可确定ACS患者的亚组，其MACE风险显着增加，应特别护理这些患者以防止过度不良结局。
