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Intra-aortic balloon pumping and thrombocytopenia in patients with acute coronary syndrome

Incidence, risk factors, and prognosis

Intraaortale Ballongegenpulsation und Thrombozytopenie bei Patienten mit akutem Koronarsyndrom

Inzidenz, Risikofaktoren und Prognose

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Abstract

Background

Thrombocytopenia is a frequently encountered phenomenon during intra-aortic balloon pumping (IABP), which may limit its prolonged utilization. The aim of the study was to explore the risk factors and clinical implications of IABP-associated thrombocytopenia in patients with acute coronary syndrome (ACS).

Methods

We retrospectively analyzed the data of 222 patients with ACS undergoing invasive treatment strategy supported by IABP. The incidence and risk factors of IABP-associated thrombocytopenia, and the association between thrombocytopenia and relevant clinical endpoints (in-hospital death, bleeding according to the TIMI scale, and thromboembolic events), were analyzed.

Results

IABP-associated thrombocytopenia was observed in 54.5% (121/222) of the patients. The incidence of thrombocytopenia was higher and the magnitude of reduction in platelet count was greater in the Arrow balloon group (n = 89) compared with the Datascope balloon group (n = 133; 68.5% vs. 45.1%, p = 0.001; 48.7% vs. 33.2%, p < 0.001; respectively). Independent predictors of thrombocytopenia included older age and Arrow balloon utilization (odds ratio [OR]: 1.054; 95% confidence interval [CI]: 1.028–1.080; p<0.001; OR: 2.468; 95%CI: 1.375–4.431; p = 0.002; respectively). The incidence of in-hospital death was higher in patients who developed thrombocytopenia than those who did not (9.1% vs. 2.0%, p = 0.041), and thrombocytopenia was correlated with in-hospital death (OR: 5.932; 95%CI: 1.221–28.822; p = 0.027). However, the rates of TIMI bleeding and thromboembolic events were similar between the two groups (5.8% vs. 5.0%, p = 1.000; 3.2% vs. 6.0%, p = 0.518; respectively), and thrombocytopenia was not associated with TIMI bleeding or thromboembolic events (OR: 0.940; 95%CI: 0.267–3.307; p = 0.923; OR: 0.541, 95%CI: 0.148–1.974, p = 0.352; respectively).

Conclusion

IABP-associated thrombocytopenia occurred in 54.5% of patients with ACS undergoing an invasive strategy and it was correlated with increased in-hospital mortality. Older age and use of the Arrow balloon may predict IABP-associated thrombocytopenia.

Zusammenfassung

Hintergrund

Die Thrombozytopenie gilt als eine häufige Komplikation beim Einsatz der intraaortalen Ballongegenpulsation (IABP), was deren Langzeitanwendung beschränken könnte. Ziel der vorliegenden Studie war es, die Risikofaktoren und klinischen Auswirkungen der IABP-assoziierten Thrombozytopenie bei Patienten mit akutem Koronarsyndrom (ACS) zu untersuchen.

Methode

Retrospektiv wurden die Daten von 222 IABP-Patienten mit ACS und invasiver Behandlungsstrategie ausgewertet. Dabei wurden die Inzidenz und Risikofaktoren der IABP-assoziierten Thrombozytopenie analysiert und der Zusammenhang zwischen Thrombozytopenie und relevanten klinischen Endpunkten (Krankenhausmortalität, TIMI-Blutung laut Kriterien gemäß „thrombolysis in myocardial infarction“ und Thromboembolien) untersucht.

Ergebnisse

Eine IABP-assoziierte Thrombozytopenie trat bei 54,5 % (121/222) der Patienten auf. Im Vergleich zu der Datascope-Ballon-Gruppe (n = 133) wurde eine höhere Inzidenz der Thrombozytopenie und eine größere Reduktion der Thrombozytenzahl in der Arrow-Ballon-Gruppe (n = 89) beobachtet (68,5 % vs. 45,1 %; p = 0,001 bzw. 48,7 % vs. 33,2 %; p < 0,001). Zu den unabhängigen Prädiktoren der Thrombozytopenie zählten höheres Alter und die Anwendung des Arrow-Ballons (Odds Ratio, OR: 1,054; 95%-Konfidenzintervall, 95%-KI: 1,028–1,080; p < 0,001 bzw. OR: 2,468; 95%-KI: 1,375–4,431; p = 0,002). Die Krankenhausmortalität war bei Thrombozytopeniepatienten höher als bei Patienten ohne Thrombozytopenie (9,1 % vs. 2,0 %; p = 0,041), dabei war die Thrombozytopenie mit der Krankenhausmortalität korreliert (OR: 5,932; 95%-KI: 1,221–28,822; p = 0,027). Die Rate an TIMI-Blutungen und Thromboembolien war jedoch zwischen beiden Gruppen vergleichbar (5,8% vs. 5,0%; p = 1,000 bzw. 3,2% vs. 6,0%; p = 0,518), und die Thrombozytopenie war weder mit einer TIMI-Blutung noch mit Thromboembolien assoziiert (OR: 0,940; 95%-KI: 0,267–3,307; p = 0,923 bzw. OR: 0,541, 95%-KI: 0,148–1,974; p = 0,352).

Schlussfolgerung

Eine IABP-assoziierte Thrombozytopenie trat bei 54,5% der ACS-Patienten unter invasiver Behandlungsstrategie auf und war mit einer erhöhten Krankenhausmortalität korreliert. Höheres Alter und die Anwendung des Arrow-Ballons können Prädiktoren einer IABP-assoziierten Thrombozytopenie sein.

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Acknowledgements

This study was supported by the National Natural Science Foundation of China (30872524) and CAMS Innovation Fund for Medical Sciences (CIFMS 2016-I2M-1-009).

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Authors and Affiliations

  1. Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, 100037, Xicheng District, Beijing, China

    Z. Sheng, H. Zhao MD, PhD, H. Yan MD, PhD, S. Jiang, Y. Guan, Y. Zhang, L. Song, C. Liu, P. Zhou, K. Liu, J. Liu & Y. Tan

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  1. Z. Sheng
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Corresponding authors

Correspondence to H. Zhao MD, PhD or H. Yan MD, PhD.

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Conflict of interest

Z. Sheng, H. Zhao, H. Yan, S. Jiang, Y. Guan, Y. Zhang, L. Song, C. Liu, P. Zhou, K. Liu, J. Liu, and Y. Tan declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Sheng, Z., Zhao, H., Yan, H. et al. Intra-aortic balloon pumping and thrombocytopenia in patients with acute coronary syndrome. Herz 43, 555–564 (2018). https://doi.org/10.1007/s00059-017-4599-5

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