血小板计数对不稳定型心绞痛或非ST段抬高型心肌梗死患者死亡率的影响

作     者：Mueller C. Neumann F.-J. Hochholzer W. 刘相飞 

作者机构：Herz-Zentrum Bad Krozingen Germany Dr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2卷第11期

页      面：24-25页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：不稳定型心绞痛 非致死性 血运重建术 冠状动脉造影 全因死亡 位组 生存分析 前瞻性队列研究 分位数 

摘      要：Background: Expanding the knowledge of pathogenesis of arteriosclerosis points at a central role of platelets in the development of acute coronary syndromes. Therefore, we sought to determine the impact of platelet count on longterm outcome in unstable angina/non-ST-segment elevation myocardial infarction(UA/NSTEMI) receiving contemporary treatment. Methods: This prospective cohort study included 1616 consecutive patients with UA/NSTEMI. All patients underwent coronary angiography and, if appropriate, subsequent catheter-based revascularization within 24 hours of admission. Patients were divided in quintiles according to platelet count. The primary end point was all-cause mortality during long-term follow-up of up to 60 months. Results: During follow-up(median 17 months, interquartile range 6-31 months), 89 deaths and 74 nonfatal myocardial infarctions occurred. Patients with higher platelet counts were younger, more often female, and had lower height and weight as compared with patients with lower platelet counts. Mortality was significantly lower among patients in the second quintile of platelet count(181-210×109/L) as compared with the other quintiles(hazard ratio 0.39, 95%CI 0.19 to 0.81, P=.011). Kaplan-Meier survival analysis showed cumulative 4-year mortality rates of 12.5%, 3.8%, 10.4%, 9.8%, and 11.4%for patients in the first, second, third, fourth, and fifth quintiles. This association persisted after multivariate adjustment. No association of platelet count and nonfatal myocardial infarctions was observed. Conclusions: We found a nonlinear association between platelet count and long-term mortality. The lowest mortality was observed in patients with a platelet count between 181 and 210×109/L.