Impact of immune thrombocytopenic purpura on clinical outcomes in patients with acute myocardial infarction.
Aged
Aged, 80 and over
Female
Hospital Mortality
Hospitalization
Humans
Length of Stay
/ statistics & numerical data
Male
Middle Aged
Myocardial Infarction
/ complications
Myocardial Revascularization
/ methods
Percutaneous Coronary Intervention
/ adverse effects
Propensity Score
Purpura, Thrombocytopenic, Idiopathic
/ complications
Risk Factors
Treatment Outcome
United States
/ epidemiology
acute myocardial infarction
bleeding complications
coronary revascularization
immune thrombocytopenic purpura
thrombocytopenia
transfusion
Journal
Clinical cardiology
ISSN: 1932-8737
Titre abrégé: Clin Cardiol
Pays: United States
ID NLM: 7903272
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
06
08
2019
revised:
14
10
2019
accepted:
21
10
2019
pubmed:
12
11
2019
medline:
11
11
2020
entrez:
12
11
2019
Statut:
ppublish
Résumé
Patients with immune thrombocytopenic purpura (ITP) admitted with acute myocardial infarction (AMI) may be challenging to manage given their increased risk of bleeding complications. There is limited evidence in the literature guiding appropriate interventions in this population. The objective of this study is to determine the difference in clinical outcomes in AMI patients with and without ITP. Using the United States national inpatient sample database, adults aged ≥18 years, who were hospitalized between 2007 and 2014 for AMI, were identified. Among those, patients with ITP were selected. A propensity-matched cohort analysis was performed. The primary outcome was in-hospital mortality. Secondary outcomes were coronary revascularization procedures, bleeding and cardiovascular complications, and length of stay (LOS). The propensity-matched cohort included 851 ITP and 851 non-ITP hospitalizations for AMI. There was no difference in mortality between ITP and non-ITP patients with AMI (6% vs7.3%, OR:0.81; 95% CI:0.55-1.19; P = .3). When compared to non-ITP patients, ITP patients with AMI underwent fewer revascularization procedures (40.9% vs 45.9%, OR:0.81; 95% CI:0.67-0.98; P = .03), but had a higher use of bare metal stents (15.4% vs 11.3%, OR:1.43; 95% CI:1.08-1.90; P = .01), increased risk of bleeding complications (OR:1.80; CI:1.36-2.38; P < .0001) and increased length of hospital stay (6.14 vs 5.4 days; mean ratio: 1.14; CI:1.05-1.23; P = .002). More cardiovascular complications were observed in patients requiring transfusions. Patients with ITP admitted for AMI had a similar in-hospital mortality risk, but a significantly higher risk of bleeding complications and a longer LOS compared to those without ITP. Further studies are needed to assess optimal management strategies of AMI that minimize complications while improving outcomes in this population.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with immune thrombocytopenic purpura (ITP) admitted with acute myocardial infarction (AMI) may be challenging to manage given their increased risk of bleeding complications. There is limited evidence in the literature guiding appropriate interventions in this population. The objective of this study is to determine the difference in clinical outcomes in AMI patients with and without ITP.
METHODS
METHODS
Using the United States national inpatient sample database, adults aged ≥18 years, who were hospitalized between 2007 and 2014 for AMI, were identified. Among those, patients with ITP were selected. A propensity-matched cohort analysis was performed. The primary outcome was in-hospital mortality. Secondary outcomes were coronary revascularization procedures, bleeding and cardiovascular complications, and length of stay (LOS).
RESULTS
RESULTS
The propensity-matched cohort included 851 ITP and 851 non-ITP hospitalizations for AMI. There was no difference in mortality between ITP and non-ITP patients with AMI (6% vs7.3%, OR:0.81; 95% CI:0.55-1.19; P = .3). When compared to non-ITP patients, ITP patients with AMI underwent fewer revascularization procedures (40.9% vs 45.9%, OR:0.81; 95% CI:0.67-0.98; P = .03), but had a higher use of bare metal stents (15.4% vs 11.3%, OR:1.43; 95% CI:1.08-1.90; P = .01), increased risk of bleeding complications (OR:1.80; CI:1.36-2.38; P < .0001) and increased length of hospital stay (6.14 vs 5.4 days; mean ratio: 1.14; CI:1.05-1.23; P = .002). More cardiovascular complications were observed in patients requiring transfusions.
CONCLUSIONS
CONCLUSIONS
Patients with ITP admitted for AMI had a similar in-hospital mortality risk, but a significantly higher risk of bleeding complications and a longer LOS compared to those without ITP. Further studies are needed to assess optimal management strategies of AMI that minimize complications while improving outcomes in this population.
Identifiants
pubmed: 31710764
doi: 10.1002/clc.23287
pmc: PMC6954382
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
50-59Informations de copyright
© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.
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