择期经皮冠状动脉介入治疗术后获得性血小板减少对患者远期预后的影响  

Impact of Acquired Thrombocytopenia After Elective Percutaneous Coronary Intervention on Longterm Outcomes of Patients With Coronary Artery Disease

作　　者：刘帅[1] 赵延延 伏蕊[1] 丰雷[1] 朱成刚[1] 尹栋[1] 窦克非[1] LIU Shuai;ZHAO Yan-yan;FU Rui;FENG Lei;ZHU Cheng-gang;YIN Dong;DOU Ke-fei(Department of Cardiology,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing（100037）,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病中心,北京市100037

出　　处：《中国循环杂志》2018年第11期1044-1048,共5页Chinese Circulation Journal

基　　金：阜外医院院所青年基金(2018-F04)

摘　　要：目的:探讨择期经皮冠状动脉介入治疗(PCI)患者术后获得性血小板减少的发生率及其危险因素,并评价其对患者远期预后的影响。方法:连续纳入2013-01至2013-12在阜外医院择期PCI患者8 271例,根据术后血小板计数水平分组,以血小板计数150×10~9/L为界将患者分为血小板正常组(血小板计数≥150×10~9/L,n=7 617)及血小板减少组(血小板计数<150×10~9/L,n=654),比较两组患者的临床和冠状动脉造影资料及平均随访30个月的远期预后情况,并分析血小板减少发生的独立预测因子。结果:8 271例患者中,PCI后发生血小板减少的共654例(7.91%),其中轻度血小板减少(100×10~9/L～150×10~9/L)共634例(7.67%),中、重度血小板减少(<100×10~9/L)20例(0.24%)。平均随访30个月,与血小板正常组相比,血小板减少组的全因死亡率(2.3%vs 1.0%P=0.0086)及心原性死亡率(1.2%vs 0.5%P=0.0261)均明显增加。其中,中、重度血小板减少患者心原性死亡率增加约13倍(HR=13.578,95%CI:1.812～101.750)、支架内血栓发生率增加约7倍(HR=7.765,95%CI:1.064～56.679)、心肌梗死发生率增加约11倍(HR=11.309,95%CI:2.749～46.530)。结论:择期PCI患者术后获得性血小板减少发生率较高,并与患者远期全因死亡及心原性死亡预后相关。Objectives： To investigate the association between acquired thrombocytopenia and long-term clinical outcome among stable coronary artery disease patients undergoing elective percutaneous coronary intervention（PCI）.Methods： We analyzed clinical data of 8 271 consecutive patients who underwent elective PCI in Fuwai Hospital from January 2013 to December 2013. Acquired thrombocytopenia was defined as platelet count 150×10~9/L after PCI in patients with normal baseline platelet count value. We compared data on demographic, clinical, laboratory, and 30-month outcome between non-thrombocytopenic and thrombocytopenic patients and identified the independent predictors of acquired thrombocytopenia post PCI. Results： Acquired thrombocytopenia developed in 654（7.91%） patients（634 [7.67%] patients had mild thrombocytopenia, 20 [0.24%] patients had moderate or severe thrombocytopenia）. Patients who developed thrombocytopenia had higher 30-month rate of all cause death（2.3% vs 1.0%, P=0.0086） and cardiogenic death（1.2% vs 0.5%, P=0.0261）. Moderate or severe thrombocytopenia was associated with a 13-fold increased risk for cardiogenic death, 7-fold increased risk for stent thrombosis,11-fold increased risk for myocardial infarction compared with patients without thrombocytopenia. Conclusions： Acquired thrombocytopenia after PCI is common in stable coronary artery disease patients and is independently associated with increased risk of long-term adverse outcome in these patients.

关 键 词：血小板减少 经皮冠状动脉介入治疗 死亡率 

分 类 号：R541[医药卫生—心血管疾病]