Percutaneous Coronary Intervention in Acute Coronary Syndrome Patients Presenting with Increased Platelet Count

Abstract Purpose The goal of this study was to explore whether the clinical benefits of percutaneous coronary intervention (PCI) are sustained in acute coronary syndrome (ACS) patients with abnormally increased platelet counts (PC). Methods Patients with elevated PC enrolled in the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome Project between July 1, 2017, and December 31, 2019 were evaluated. Elevated PC was defined as a baseline PC ≥ 300 × 109/L. The primary outcome was net adverse clinical events (NACEs), which included major adverse cardiovascular or cerebrovascular events (defined as cardiac death, myocardial infarction, ischemic stroke, and stent thrombosis) and major bleeding, during the index hospitalization. The risk of NACEs was compared between the PCI and non-PCI arms by multivariable analysis and inverse probability of treatment weighting. Results Among 4,526 patients, the proportion of patients receiving PCI decreased with increasing PC, and 3,046 patients ultimately underwent PCI. Those patients had a lower rate of NACEs (adjusted odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.37–0.78; P = 0.001) and a lower risk for ischemic events (adjusted OR: 0.33; 95% CI: 0.22–0.50; P < 0.001). No in-group differences in major bleeding were identified (adjusted OR: 1.41; 95% CI: 0.62–3.18; P = 0.41). Similar findings were obtained in inverse probability of treatment weighting. Conclusion In ACS patients with increased PC who have more complex thrombohemorrhagic profile, PCI can effectively reduce the risk of ischemic events without increasing the risk of bleeding. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique Identifier: NCT02306616.