Reprint of “Decline in platelet count and long-term post-PCI ischemic events: Implication of the intra-aortic balloon pump” ☆ Michele Schiariti a,b , Patrizia Saladini b , Domenico Cuturello a , Loredana Iannetta a,b , Concetta Torromeo a , Paolo Emilio Puddu a, ⁎ a Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Italy b Sant'Anna Hospital, Catanzaro, Italy abstract article info Article history: Received 24 September 2013 Received in revised form 23 October 2013 Accepted 2 November 2013 Available online 18 March 2014 Keywords: Platelet count Thrombocytopenia PCI Outcome Ischemic events Aims: Thrombocytopenia (TC) following a percutaneous coronary intervention (PCI) has been associated not only with hemorrhagic, but also with ischemic outcomes. The purpose of this study was to re-examine the relation- ship of TC with ischemic events at a 1-year follow-up, and investigate the possible associations. Methods and results: We studied a real-world, unselected population of ischemic patients undergoing PCI, totaling 861 patients-year, and divided into two groups: with TC (delta platelet count ≥25% from baseline to post-PCI during the hospital admission) and without TC. Compared with patients without TC, patients with TC had a higher and earlier incidence of both hemorrhagic and ischemic events. In them, the use of intra-aortic balloon pump (IABP) was ten-fold higher. In Kaplan–Meier curves assessing the contribution of both TC and IABP to outcome, IABP was a univariate detrimental factor additive to the role of TC. In a forced Cox model, the relative decline (delta) in platelet count (p = 0.05) and the use of IABP (p = 0.0001) were both associated with ische- mic outcomes. After excluding all patients with IABP, the delta platelet count was no longer significantly associ- ated with ischemic outcomes (p = 0.66). After excluding all patients with shock and all those who undergone thrombolysis, there was still a relationship (p = 0.0042) between the delta platelet count and ischemic events. Conclusions: In this patient population the use of IABP, but not thrombocytopenia per se, is a possible primary cause of worse ischemic outcomes. © 2014 Elsevier Inc. All rights reserved. 1. Introduction A decline in platelet count following percutaneous coronary inter- vention (PCI) is not rare, and might be related to multiple factors, in- cluding the use of antithrombotic medications — particularly heparin, therapies with thrombolytic drugs, glycoprotein IIb/IIIa inhibitors (GPI) [1–3], or – less commonly – statins [4–6], ACE-inhibitors [7] or clopidogrel [8]; and, mechanically, the use of intra-aortic balloon pump (IABP) [9]. When the decline in platelet count reaches a threshold value of ≥25% [10], as a change during the post-PCI hospital stay, it has been associated with a higher risk of bleeding and death [11]. While the relationship of thrombocytopenia with bleeding events is not surprising [12,13], ischemic events may also be paradoxically increased, as illustrated by several recent reports [14–18]. The hypothesis has been raised that thrombocytopenia (TC) is itself causal in determining ischemic events; however, the possibility of non- causative association also exists. De Labriolle et al. explored the associa- tion between PCI-related TC and adverse outcomes [10]: first, they confirmed, in a large unselected (real world) group of patients, that post-procedural TC during the hospital stay was independently associat- ed with a higher incidence of both adverse ischemic events and hemor- rhagic complications; second, they reported that this association, while stronger with a severe (≥50%) platelet count decline, was not only lim- ited to the usual criteria for acquired TC, but also present with relatively more modest (≥25%) degrees [17]. It is of note, however, that IABP was used in a larger percentage (52 of 398, 23.1%) of post-PCI patients achieving a ≥50% decline in platelet count as compared with only 2.2% (79 of 6543) of patients with a milder (b 10%) decline in platelet count, a significant difference at the univariate analysis, which did not however contribute significantly in a predictive 1-month stepwise Cox model [10]. The purpose of this investigation was therefore to examine the predictive power of a decline in platelet count, assessed as a continuous Vascular Pharmacology 61 (2014) 35–41 ☆ This article is a reprint of a previously published article. The article is reprinted here for the reader’s convenience. For citation purposes, please use the original publication details; Vascular Pharmacology, 60(1), pp. 25–31. DOI of original article: http://dx.doi.org/10.1016/j.vph.2013.11.002. ⁎ Corresponding author at: Laboratory of Biotechnologies Applied to Cardiovascular Medicine, Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy. Tel.: +39 06 49972654; fax: +39 06 4453891. E-mail address: paoloemilio.puddu@uniroma1.it (P.E. Puddu). 1537-1891/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.vph.2014.03.003 Contents lists available at ScienceDirect Vascular Pharmacology journal homepage: www.elsevier.com/locate/vph