非ST段抬高型心肌梗死(NSTEMI)的免疫性血小板减少症(ITP)患者由于抗血小板和抗凝治疗的出血风险增加而面临独特的治疗挑战。研究该人群的医院死亡率和并发症的证据有限。该研究包括来自2018-2021年全国住院患者样本数据库的患者队列。倾向评分使用1:1的匹配比率匹配有和没有ITP的NSTEMI患者。结果分析为住院死亡率,诊断血管造影率,经皮冠状动脉介入治疗(PCI),急性肾损伤(AKI),充血性心力衰竭(CHF),心源性休克,心脏骤停,机械通气,气管插管,室性心动过速(VT),心室纤颤(VF),大出血,需要输血和血小板,停留时间(LOS)和总住院费用。共有1,699,020名患者符合纳入标准(660,490名女性[39%],主要是白种人1,198,415(70.5%);平均[SD]年龄67,[3.1],包括2,615名(0.1%)ITP患者。在倾向匹配之后,有和没有ITP的1,020例NSTEMI患者匹配。ITP患者住院死亡率较高(aOR1.98,95%CI1.11-3.50,p0.02),心源性休克,AKI,机械通气,气管插管,红细胞和血小板输注,较长的LOS,和更高的总住院费用。诊断血管造影的比率,PCI、CHF、VT,VF,大出血两组间无差异。ITP患者因NSTEMI住院死亡率较高,需要输注血小板,而诊断血管造影或PCI的发生率无差异。
Patients with immune thrombocytopenia (ITP) admitted for non-ST elevation myocardial infarction (NSTEMI) present a unique therapeutic challenge due to the increased risk of bleeding with antiplatelet and anticoagulation therapies. There is limited evidence studying hospital mortality and complications in this population. The study included a patient cohort from the 2018-2021 National Inpatient Sample database. Propensity score matched NSTEMI patients with and without ITP using a 1:1 matching ratio. Outcomes analyzed were in-hospital mortality, rates of diagnostic angiogram, percutaneous coronary intervention (PCI), acute kidney injury (AKI), congestive heart failure (CHF), cardiogenic shock, cardiac arrest, mechanical ventilation, tracheal intubation, ventricular tachycardia (VT), ventricular fibrillation (VF), major bleeding, need for blood and platelet transfusion, length of stay (LOS), and total hospitalization charges. A total of 1,699,020 patients met inclusion criteria (660,490 females [39%], predominantly Caucasian 1,198,415 (70.5%); mean [SD] age 67, [3.1], including 2,615 (0.1%) patients with ITP. Following the propensity matching, 1,020 NSTEMI patients with and without ITP were matched. ITP patients had higher rates of inpatient mortality (aOR 1.98, 95% CI 1.11-3.50, p 0.02), cardiogenic shock, AKI, mechanical ventilation, tracheal intubation, red blood cells and platelet transfusions, longer LOS, and higher total hospitalization charges. The rates of diagnostic angiogram, PCI, CHF, VT, VF, and major bleeding were not different between the two groups. Patients with ITP demonstrated higher odds of in-hospital mortality for NSTEMI and need for platelet transfusion with no difference in rates of diagnostic angiogram or PCI.