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Background: Acquired thrombocytopenia (aTP) is associated with a high frequency of bleeding and ischemic complications in patients undergoing percutaneous coronary intervention (PCI). Herein, we report a meta-analysis evaluating the adverse effects of aTP on cardiovascular outcomes and mortality post-PCI., Methods: A literature search was performed using PubMed, Embase, Cochrane and, clinicaltrials.gov from the inception of these databases through October 2019. Patients were divided into two groups: 1) No Thrombocytopenia (nTP) and 2) Acquired Thrombocytopenia (aTP) after PCI. Primary endpoints were in-hospital, 30-day and all-cause mortality rates at the longest follow-up. The main summary estimate was random effects Risk ratio (RR) with 95% confidence intervals (CIs)., Results: Seven studies involving 57,247 participants were included. There was significantly increased in-hospital all-cause mortality (HR 10.73 [6.82-16.88]), MACE (HR 2.96 [2.24-3.94]), major bleeding (HR 4.78 [3.54-6.47]), and target vessel revascularization (TVR) (HR 7.53 [2.8-20.2]), in the aTP group compared to the nTP group. Similarly, aTP group had a statistically significant increased incidence of 30-day all-cause mortality (HR 6.08), MACE (HR 2.77), post-PCI MI (HR 1.98), TVR (HR 5.2), and major bleeding (HR 12.73). Outcomes at longest follow-up showed increased incidence of all-cause mortality (HR 3.98 [1.53-10.33]) and MACE (HR 1.24 [0.99-1.54]) in aTP group, while there was no significant difference for post-PCI MI (HR 0.94 [0.37-2.39]) and TVR (HR 0.96 [0.69-1.32]) between both groups., Conclusions: Acquired Thrombocytopenia after PCI is associated with increased morbidity, mortality, adverse bleeding events and the need for in-hospital and 30-day TVR., Competing Interests: Declaration of competing interest All authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease. Coronary angiography (CAG) and percutaneous coronary intervention (PCI) are frequently performed in patients presenting with a non-ST elevation myocardial infarction (NSTEMI). Utilizing the National Inpatient Sample database, we assessed the trends in utilization of CAG, PCI, and coronary artery bypass grafting in 3,654,586 admissions with NSTEMI from 2001 to 2012. The rates of CAG were 54%, 36.1%, and 45.9%, respectively, in patients with normal renal function, patients with CKD not on renal replacement therapy (RRT), and patients with CKD requiring RRT. The in-hospital mortality for patients with NSTEMI was significantly higher in patients with CKD-3.9% in patients without CKD, 6.9% in CKD patients not on RRT, and 8.6% in CKD patients needing RRT. In a propensity-matched cohort of 126,740 NSTEMI admissions, CKD was associated with increased in-hospital mortality (7.9% vs 5.3%, p <0.001), acute kidney injury (34.3 % vs 10.6%, p <0.001), lower use of CAG (37.8% vs 46.4%, p <0.001), and PCI (16.2% vs 20.8, p <0.001), higher hospital costs ($17,333 vs $15,583, p <0.001), and a longer length of stay (6.8 days vs 5.5 days, p <0.001). PCI was associated with decreased mortality (odds ratio of 0.31 ± 0.01, p <0.001) in all the 3 groups. In conclusion, CKD is a marker of adverse outcomes in patients with NSTEMI. Although CAG and PCI were associated improved outcomes, they remain underutilized in these patients., (Copyright © 2018. Published by Elsevier Inc.)