PB0026 - Low platelet count has a strong worsening impact on outcome in patients with acute coronary syndromes: from the START Antiplatelet registry

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Co-Author(s)

Giuseppe Guglielmini, PhD

Biologist, PhD
Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia
Perugia, Umbria, Italy

Co-Author(s)

MD

Maurizio Del Pinto

MD, PhD
Division of Cardiology, Perugia Hospital
Perugia, Umbria, Italy
PC

Paolo Calabrò

Professor
Dept. of Translational Medical Sciences, University of Campania "Luigi Vanvitelli"
Napoli, Campania, Italy
Pasquale Pignatelli, PhD

Professor
Dept. of Clinical, Internistic, Anesthesiologic and Cardiovascular Sciences, Sapienza University
Roma, Lazio, Italy
GP

Giuseppe Patti

Professor
Dept. of Translational Medicine, University of Eastern Piedmont
Novara, Piemonte, Italy
VP

Vittorio Pengo

Professor
Dept. of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova
Padova, Veneto, Italy
EA

Emilia Antonucci

Researcher
Fondazione Arianna
Bologna, Emilia-Romagna, Italy
PC

Plinio Cirillo

Professor
Division of cardology, Dept. of Advanced Biomedical Sciences, "Federico II" University
Napoli, Campania, Italy
TF

Tiziana Fierro

MD, PhD
Dept. of Medicine and Surgery, University of Perugia
Perugia, Umbria, Italy
GP

Gualtiero Palareti

Professor
Arianna Foundation on Anticoagulation
Bologna, Emilia-Romagna, Italy
RM

Rossella Marcucci

Professor
Dept. of Experimental and Clinical Medicine, University of Florence
Firenze, Toscana, Italy

Presenting Author(s)

Paolo Gresele, MD, PhD

Professor
Dept. of Medicine and Surgery, University of Perugia
Perugia, Umbria, Italy

Background: Previous observations suggest that a low platelet count associates with an increased risk of adverse outcome in patients with acute coronary syndromes (ACS). However, most were from post-hoc analyses of randomized clinical trials, many of which performed several years ago.

Aims: To assess the impact of low platelet count on cardiovascular outcome and treatment decisions in patients hospitalized for ACS in a current real-life setting in Italy.

Methods: START-ANTIPLATELET is a multicenter registry enrolling ACS patients admitted to Italian coronary care units and treated by PCI or medical therapy. Baseline characteristics and treatment at discharge were recorded and follow-up reassessments were repeated at 6-months, 1-year and yearly thereafter. Low count was defined as < 150k/µL platelets on admission. MACCE were cardiovascular death, non-fatal MI, TIA, ischemic stroke, target vessel revascularization and major arterial ischemic events. NACE, were MACCE plus major bleeding.

Results: Among 1890 enrolled ACS patients, 9.9% had a platelet count < 150k/µl (11.2% women) and 1.9% < 100k/µl (17.2% women). Patients < 150k/µl platelets were older (71±10.9 vs 65.6±12.5 years, p< 0.0001), had higher incidence of NVAF (17.1% vs 8.6%, p=0.02), and previous stroke (22.5% vs 8.7%, p=0.01). At hospitalization patients with < 150k/µl platelets had significantly lower hemoglobin (p < 0.001), hematocrit (p < 0.0001) and GFR (p=0.001) (Table 1)
Clinical presentation and type of revascularization were similar however low platelet count patients were discharged more frequently on single and not dual antiplatelet therapy (15.2% vs 8.9%, p=0.028).
MACCE-free survival time was significantly shorter in patients with low platelets (Fig. 1). Also NACE occurred significantly more frequently ( < 150k/µl=15.2% vs 8.4%, p=0.02).

Conclusion(s): Low platelet count identifies a subgroup of ACS patients at increased risk of adverse outcome. ACS patients with low platelet count should be managed with special care to prevent excess adverse outcome.