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546

A DECREASED PLATELET COUNT AT BASELINE IS ASSOCIATED WITH WORSE IN-HOSPITAL OUTCOME AFTER PERCUTANEOUS CORONARY INTERVENTION

P Lim, E Horlick, M Todorov, K Mackie, PR McLaughlin, L Schwartz, P Seidelin, V Dzavik

Toronto, Ontario

BACKGROUND: The outcome after percutaneous coronary intervention (PCI) in patients with pre-existing thrombocytopenia is not well documented. The aim of this study was to examine the acute in-hospital outcome of patients undergoing PCI who have a low platelet count, compared to those with a normal baseline platelet count (BP) in a setting of routine periprocedural administration of platelet 2b/3a inhibitors (GPI).

METHODS: We examined all PCI cases performed at the Toronto General Hospital between 04/2000 and 06/2003. Baseline, procedural and outcome variables were collected prospectively and entered in the PCI Registry. Only patients (n=5083) for whom a baseline platelet count was recorded were included in this analysis. Patients were assigned to 2 groups: 1) BPC <120,000 (LPC), and 2) BPC ³120,000 (NPC). Continuous variables were analyzed with the Student’s t-test and categorical variables with c2. Multivariable analysis examining predictors of MACE was performed using logistic regression. MACE was defined as death, MI, abrupt closure or CABG.

RESULTS: LPC patients (n=99) were older (66 vs. 63 years, p=0.006), more likely male (82% vs 72%, p=0.03), diabetic (38% vs 26%, p=0.008), with a creatinine >133 mmol/L (36% vs 10%, p<0.0001), and were more likely to have an emergent PCI (8% vs 4%, p=0.05) and prior CABG (25% vs 18%, p=0.05). GPI were used in 92% of patients with LPC and 96% of those with NPC (p=0.03) Only creatinine >133 mmol/L was an independent predictor of LPC at baseline. Presence of LPC at baseline was an independent predictor of MACE after PCI (OR 2.54, 95%CI 1.18, 4.92, p<0.01, along with emergent PCI (p<0.0001), baseline creatinine (p=0.0001), number of diseased vessels (p=0.0003), number of PCI lesions (p=0.002), age (0.008) and female sex (p=0.012).

CONCLUSIONS: Baseline LPC in patients undergoing PCI occurs more frequently in patients with creatinine >133 mmol/L, and is an independent predictor of MACE. The mechanisms for this are not clear but may possibly be related to platelet dysfunction in affected patients, especially in those with renal dysfunction.

DNC

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