Abstract
BackgroundThe impact of thrombocytopenia on infection in patients with ST-elevation myocardial infarction (STEMI) remains poorly understood.AimsTo evaluate the association between thrombocytopenia and infection in patients with STEMI.MethodsPatients diagnosed with STEMI were identified from January 2010 to June 2016. The primary endpoint was in-hospital infection, and major adverse clinical events (MACE) and all-cause death were considered as secondary endpoints.ResultsA total of 1401 STEMI patients were enrolled and divided into two groups according to the presence (n = 186) or absence (n = 1215) of thrombocytopenia. The prevalence of in-hospital infection was significantly higher in the thrombocytopenic group (30.6% (57/186) vs. 16.2% (197/1215), p < 0.001). Prevalence of in-hospital MACE (30.1% (56/186) vs. 16.4% (199/1215), p < 0.001) and all-cause death (8.1% (15/186) vs. 3.8% (46/1215), p = 0.008) revealed an increasing trend. Multivariate analysis indicated that thrombocytopenia was independently associated with increased in-hospital infection (OR, 2.09; 95%CI 1.32–3.27; p = 0.001) and MACE (1.92; 1.27–2.87; p = 0.002), but not all-cause death (1.87; 0.88–3.78; p = 0.091). After a median follow-up of 2.85 years, thrombocytopenia was not associated with all-cause death at multivariable analysis (adjusted hazard ratio, 1.19; 95%CI 0.80–1.77; p = 0.383).ConclusionsThrombocytopenia is significantly correlated with in-hospital infection and MACE, and might be used as a prognostic tool in patients with STEMI.
Highlights
The impact of thrombocytopenia on infection in patients with ST-elevation myocardial infarction (STEMI) remains poorly understood
A total of 2283 patients with STEMI at our hospital were identified between January 2010 and June 2016; of these, 882 patients were excluded according to the exclusion criteria
Thrombocytopenic patients had a higher prevalence of myocardial infarction and new use of antibiotics compared with non-thrombocytopenia cases
Summary
The impact of thrombocytopenia on infection in patients with ST-elevation myocardial infarction (STEMI) remains poorly understood. Infection is an uncommon (reported prevalence of 2.4%) but potentially devastating complication in patients with ST-elevation myocardial infarction (STEMI). Infection in these patients is usually associated with a significantly increased risk of mortality and morbidity, prolongs hospitalization, and increases healthcare costs [1,2,3]. Thrombocytopenia is a common laboratory abnormality in patients presenting with acute myocardial infarction (AMI) and always defined as a platelet count < 150 × 109/L [4]. Thrombocytopenia has been previously considered as a risk factor for worse outcomes and has been reported to be independently associated with in-hospital mortality in ACS patients [6]. Infectious agents play a crucial role for their contribution to a reduction in the platelet count by suppressing the bone marrow directly or increasing peripheral consumption of platelets [7,8,9]
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