The prognostic value of platelet count on admission in patients with type B acute aortic dissection after endovascular therapy_West China Medical Journal

Authors：

LAI Qiang , LI Dongze , GAO Yongli , ZHANG Haihong , CHEN Yao , WAN Zhi ,  CAO Yu

Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

CAO Yu, Email: yuyuer@126.com

Keywords：

Platelet count; Type B acute aortic dissection; Endovascular therapy; Prognosis

DOI：

10.7507/1002-0179.201710142

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ObjectivesTo explore the predictive value of platelet count at admission for long-term prognosis in patients with type B acute aortic dissection (AAD) undergoing endovascular therapy (EVT). MethodsWe investigated 131 consecutive patients with type B AAD after EVT in West China Hospital of Sichuan University from January to December 2012. The patients’ basic clinical data, blood test results, major adverse cardiovascular events, and in-hospital and out-hospital survival status were collected. According to the tri-sectional quantiles of platelet counts, the patients were divided into three groups. Chi-square test was used to analyze the correlation between platelet count and hospital complications. Kaplan-Meier survival analysis and Cox regression analysis were used to analyze the relationship between platelet count and survival in patients with type B AAD. The primary endpoint was all-cause death. ResultsThe overall in-hospital mortality of the 131 patients was 9.9%, and the mortality was 16.0% by the end of the follow-up, the median length of which was 2.1 years. There were 44 cases in T1 group (platelet count >200×10 ⁹/L), 44 cases in T2 group [platelet count (155–200)×10⁹/L], and 43 cases in T3 group [platelet count ≤155×10⁹/L]. The mortality in T3 group (30.2%) was higher than that in T1 group (4.5%) and T2 group (13.6%) (P=0.004). Kaplan-Meier survival analysis showed that the cumulative survival rate of T3 group was significantly lower than that of T1 group and T2 group (69.8% vs. 95.5%, χ²=10.165, P=0.001; 69.8% vs. 86.4%, χ²=5.174, P=0.037). Cox multivariate analysis showed that age [hazard ratio (HR)=1.043, 95% confidence interval (CI) (1.009, 1.079), P=0.013], heart rate [HR=1.030, 95%CI (1.004, 1.058), P=0.024], and platelet count [HR=6.011, 95%CI (1.319, 27.391), P=0.020] were independent risk factors for mortality. Older age, rapid heart rate, and lower platelet count would increase the risk of death. ConclusionPlatelet count may be an independent factor that affects the prognosis of patients with type B AAD after EVT, and a low platelet count at admission increases the risk of death.

Citation： LAI Qiang, LI Dongze, GAO Yongli, ZHANG Haihong, CHEN Yao, WAN Zhi, CAO Yu. The prognostic value of platelet count on admission in patients with type B acute aortic dissection after endovascular therapy. West China Medical Journal, 2018, 33(11): 1395-1399. doi: 10.7507/1002-0179.201710142 Copy

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11.	田力, 樊曉寒, 朱俊, 等. A 型急性主動脈夾層患者血漿 D-二聚體濃度和住院死亡的關系. 中華高血壓雜志, 2014, 28(2): 200.
12.	Thygesen K, Alpert JS, Jaffe AS, et al. Third Universal definition of myocardial infarction. Circulation, 2012, 33(20): 2551-2567.
13.	Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract, 2012, 120(4): C179-C184.
14.	Gargiulo M, Bianchini Massoni C, Gallitto E, et al. Lower limb malperfusion in type B aortic dissection: a systematic review. Ann Cardiothorac Surg, 2014, 3(4): 351-367.
15.	Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2014, 45(12): 3754-3832.
16.	Suzuki T, Mehta RH, Ince H, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation, 2003, 108(Suppl 1): II312-II317.
17.	Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
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19.	Sbarouni E, Georgiadou P, Kosmas E. Platelet to lymphocyte ratio in acute aortic dissection. J Clin Lab Anal, 2018, 32(7): e2244.
20.	He RX, Zhang L, Zhou TN, et al. Safety and necessity of antiplatelet therapy on patients underwent endovascular aortic repair with both stanford type B aortic dissection and coronary heart disease. Chin Med J (Engl), 2017, 130(19): 2321-2325.
21.	Sbarouni E, Georgiadou P. Significant changes in platelet count, volume and size in acute aortic dissection. Int J Cardiol, 2013, 168(4): 4349-4350.
22.	何謙, 古君, 秦超毅, 等. 血小板激活在急性主動脈夾層并發全身炎癥反應中的作用. 華西醫學, 2016, 31(6): 1004-1007.
23.	Huang B, Tian L, Fan X, et al. Low admission platelet counts predicts increased risk of in-hospital mortality in patients with type A acute aortic dissection. Int J Cardiol, 2014, 172(3): e484-e486.

1. 徐新兵. 主動脈夾層早期診斷研究進展. 中西醫結合心血管病電子雜志, 2016, 4(16): 16-17.
2. 王進, 劉一帆, 王利, 等. 主動脈夾層研究進展. 實用醫院臨床雜志, 2016, 13(4): 209-212.
3. 趙珺. Stanford B 型主動脈夾層全程腔內根治性修復術: 概念與方案. 中國血管外科雜志: 電子版, 2016, 8(1): 16-19.
4. 戈小虎, 方青波, 管圣, 等. Stanford B 型主動脈夾層的腔內治療 (附 134 例報告). 中國微創外科雜志, 2012, 12(9): 774-776.
5. 楊潔連, 向定成, 肖華, 等. 急性 Stanford B 型主動脈夾層腔內修復治療時機與預后的關系. 中國介入心臟病學雜志, 2014(5): 300-303.
6. 陳昭然, 黃畢, 劉斯思, 等. Stanford B 型主動脈夾層臨床資料分析. 中國分子心臟病學雜志, 2014(5): 1051-1054.
7. 龐興學, 王顯. 血栓形成的過程與機制研究進展. 醫學綜述, 2011, 17(11): 1613-1616.
8. Morello F, Piler P, Novak M, et al. Biomarkers for diagnosis and prognostic stratification of aortic dissection: challenges and perspectives. Biomark Med, 2014, 8(7): 931-941.
9. Paparella D, Rotunno C, Guida P, et al. Hemostasis alterations in patients with acute aortic dissection. Ann Thorac Surg, 2011, 91(5): 1364-1370.
10. Balduini CL, Salvini M, Montani N, et al. Activation of the hemostatic process in patients with unruptured aortic aneurysm before and in the first week after surgical repair. Haematologica, 1997, 82(5): 581-583.
11. 田力, 樊曉寒, 朱俊, 等. A 型急性主動脈夾層患者血漿 D-二聚體濃度和住院死亡的關系. 中華高血壓雜志, 2014, 28(2): 200.
12. Thygesen K, Alpert JS, Jaffe AS, et al. Third Universal definition of myocardial infarction. Circulation, 2012, 33(20): 2551-2567.
13. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract, 2012, 120(4): C179-C184.
14. Gargiulo M, Bianchini Massoni C, Gallitto E, et al. Lower limb malperfusion in type B aortic dissection: a systematic review. Ann Cardiothorac Surg, 2014, 3(4): 351-367.
15. Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2014, 45(12): 3754-3832.
16. Suzuki T, Mehta RH, Ince H, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation, 2003, 108(Suppl 1): II312-II317.
17. Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
18. Li D, Ye L, Yu J, et al. Significance of the thrombo-inflammatory status-based novel prognostic score as a useful predictor for in-hospital mortality of patients with type B acute aortic dissection. Oncotarget, 2017, 8(45): 79315-79322.
19. Sbarouni E, Georgiadou P, Kosmas E. Platelet to lymphocyte ratio in acute aortic dissection. J Clin Lab Anal, 2018, 32(7): e2244.
20. He RX, Zhang L, Zhou TN, et al. Safety and necessity of antiplatelet therapy on patients underwent endovascular aortic repair with both stanford type B aortic dissection and coronary heart disease. Chin Med J (Engl), 2017, 130(19): 2321-2325.
21. Sbarouni E, Georgiadou P. Significant changes in platelet count, volume and size in acute aortic dissection. Int J Cardiol, 2013, 168(4): 4349-4350.
22. 何謙, 古君, 秦超毅, 等. 血小板激活在急性主動脈夾層并發全身炎癥反應中的作用. 華西醫學, 2016, 31(6): 1004-1007.
23. Huang B, Tian L, Fan X, et al. Low admission platelet counts predicts increased risk of in-hospital mortality in patients with type A acute aortic dissection. Int J Cardiol, 2014, 172(3): e484-e486.

West China Medical Journal

The prognostic value of platelet count on admission in patients with type B acute aortic dissection after endovascular therapy

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