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Original research
Baseline platelet count in percutaneous coronary intervention: a dose–response meta-analysis
  1. Akhmetzhan Galimzhanov1,
  2. Yersyn Sabitov2,
  3. Erhan Tenekecioglu3,4,
  4. Han Naung Tun5,
  5. Mirvat Alasnag6,
  6. Mamas A Mamas7
  1. 1 Department of Cardiology and Interventional Arrhythmology, Semey Medical University, Semey, Kazakhstan
  2. 2 Rentgen-endovascular Laboratory, Semey Medical University, Semey, East Kazakhstan, Kazakhstan
  3. 3 Department of Cardiology, Bursa Training and Research Hospital, Bursa, Turkey
  4. 4 Department of Cardiology, Erasmus University Rotterdam, Rotterdam, The Netherlands
  5. 5 Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
  6. 6 Cardiovascular Department, King Fahd Armed Forces Hospital, Jeddah, Makkah, Saudi Arabia
  7. 7 Keele Cardiovascular Research Group, Keele University, Keele, UK
  1. Correspondence to Dr Akhmetzhan Galimzhanov, Department of Cardiology and Interventional Arrhythmology, Semey Medical University, Semey 575018, Kazakhstan; ahmed.galimzhan{at}


Objectives The nature of the relationship between baseline platelet count and clinical outcomes following percutaneous coronary intervention (PCI) is unclear. We undertook dose–response and pairwise meta-analyses to better describe the prognostic value of the initial platelet count and clinical endpoints in patients after PCI.

Methods A search of PubMed, Scopus and Web of Science (up to 9 October 2021) was performed to identify studies that evaluated the association between platelet count and clinical outcomes following PCI. The primary outcomes of interest were all-cause mortality, major adverse cardiovascular events (MACE) and major bleeding. We performed random-effects pairwise and one-stage dose–response meta-analyses by calculating HRs and 95% CIs.

Results The meta-analysis included 19 studies with 217 459 patients. We report a J-shaped relationship between baseline thrombocyte counts and all-cause death, MACE and major bleeding at follow-up. The risk of haemorrhagic events exceeded the risk of thrombotic events at low platelet counts (<175×109/L), while a predominant ischaemic risk was observed at high platelet counts (>250×109/L). Pairwise meta-analyses revealed a robust link between initial platelet counts and the risk of postdischarge all-cause mortality, major bleeding (for thrombocytopenia: HR 1.39, 95% CI 1.30 to 1.49; HR 1.51, 95% CI 1.15 to 2.00, respectively) and future death from any cause and MACE (thrombocytosis: HR 1.60, 95% CI 1.29 to 1.98; HR 1.47, 95% CI 1.22 to 1.78, respectively).

Conclusion Low platelet counts were associated with the predominant bleeding risk, while high platelet counts were only associated with the ischaemic events.

PROSPERO registration number CRD42021283270.

  • coronary artery disease
  • meta-analysis
  • percutaneous coronary intervention
  • systematic reviews as topic
  • acute coronary syndrome

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors All authors contributed to the study design and conception, screening, extraction, data preparation, analyses, interpretation of the results and manuscript writing. All authors read and approved the final version of the manuscript. All authors guarantee the accuracy and integrity of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.