就诊时血小板计数与ST段抬高型心肌梗死临床预后之间的相关性(来自TIMI试验)

Platelet activation and aggregation play pivotal roles in the thrombotic process of acute coronary syndromes. However, data regarding platelet count and its association with clinical outcomes in the setting of ST-elevation myocardial infarction(STEMI) are limited. We hypothesized that higher platelet counts on presentation would be associated with poorer clinical outcomes. Data from 10,793 patients with STEMI in the Thrombolysis In Myocardial Infarction(TIMI) trials database were analyzed. Mean platelet count on presentation was 254.8×103/μl. Higher platelet counts were associated with higher rates of adverse clinical outcomes at 30 days. In a multivariable analysis that adjusted for confounders of platelet counts(age, gender, weight, diabetes, and smoking), higher platelet counts remained associated with an increased risk of the combined end point of death, reinfarction, and congestive heart failure. With a reference group of platelet counts< 200×103/μl, the multivariable odds ratios were 1.22(95%confidence interval 1.05 to 1.42, p=0.009) for platelet counts of 201 to 300×103/μl, 1.37(95%confidence interval 1.11 to 1.68, p=0.002) for counts of 301 to 400×103/μl, and 1.71(95%confidence interval 1.16 to 2.51, p=0.005) for counts >400×103/μl. Further, a greater decrease in follow-up platelet counts(compared with baseline values) was independently associated with an increased risk of reinfarction at 30 days(odds ratio 1.44 for every decrease of 100×103/μl unit of platelets, 95%confidence interval 1.13 to 1.82, p=0.03). In conclusion, in STEMI, a higher platelet count on presentation was independently associated with adverse clinical outcomes, whereas a greater subsequent platelet count decrease was associated with an increased risk of reinfarction.

接受经皮冠状动脉介入和依替巴肽治疗的中高危患者中出血事件的相关因素:来自PROTECT-TIMI-30试验的观察

Objectives: We aimed to identify correlates of Thrombolysis In Mycocardial Infarction(TIMI) major/minor bleeding among eptifibatide-treated patients undergoing percutaneous coronary intervention(PCI). Background: Evaluation of bleeding predictors among patients treated with glycoprotein IIb/IIIa receptor inhibition might aid in the identification of targets to reduce bleeding risk. Methods: Data were analyzed from 567 moderate-to high-risk PCI patients with non-ST-segment elevation acute coronary syndrome(NSTEACS) treated with eptifibatide/reduced-dose unfractionated heparin or eptifibatide/ reduced-dose enoxaparin enrolled in the Randomized Trial to Evaluate the Relative Protection Against Post-PCI Microvascular Dysfunction and Post-PCI Ischemia Among Anti-Platelet and Anti-Thrombotic Agents-Thrombolysis In Myocardial Infarction-30(PROTECT-TIMI-30). Results: The incidence of significant bleeding was 3.2%with a median time to event of 7.0 h after the first eptifibatide bolus. Increased age was the only independent correlate of bleeding events. Among patients with reduced creatinine clearance(CrCl), lack of adjustment of the maintenance infusion for CrCl ≤50 ml/min occurred frequently(15 of 33 patients, or 45%) and was associated with a high rate of bleeding(20%). The association of CrCl with bleeding appeared to be largely mediated by the incorporation of age in the estimation of CrCl. Patient gender, Cr, weight, and the peak activated clotting time were not associated with bleeding. Conclusions: Among NSTEACS PCI patients treated with eptifibatide, increased age was a significant correlate of bleeding events and appeared to explain the association between low CrCl and bleeding. The more widespread use of CrCl or other estimates of renal function over Cr may lead to more appropriate dose adjustments of eptifibatide.