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

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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

1.	徐新兵. 主动脉夹层早期诊断研究进展. 中西医结合心血管病电子杂志, 2016, 4(16): 16-17.
2.	王进, 刘一帆, 王利, 等. 主动脉夹层研究进展. 实用医院临床杂志, 2016, 13(4): 209-212.
3.	赵珺. Stanford B 型主动脉夹层全程腔内根治性修复术: 概念与方案. 中国血管外科杂志: 电子版, 2016, 8(1): 16-19.
4.	戈小虎, 方青波, 管圣, 等. Stanford B 型主动脉夹层的腔内治疗 (附 134 例报告). 中国微创外科杂志, 2012, 12(9): 774-776.
5.	杨洁连, 向定成, 肖华, 等. 急性 Stanford B 型主动脉夹层腔内修复治疗时机与预后的关系. 中国介入心脏病学杂志, 2014(5): 300-303.
6.	陈昭然, 黄毕, 刘斯思, 等. Stanford B 型主动脉夹层临床资料分析. 中国分子心脏病学杂志, 2014(5): 1051-1054.
7.	庞兴学, 王显. 血栓形成的过程与机制研究进展. 医学综述, 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, 樊晓寒, 朱俊, 等. A 型急性主动脉夹层患者血浆 D-二聚体浓度和住院死亡的关系. 中华高血压杂志, 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.	何谦, 古君, 秦超毅, 等. 血小板激活在急性主动脉夹层并发全身炎症反应中的作用. 华西医学, 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. 主动脉夹层早期诊断研究进展. 中西医结合心血管病电子杂志, 2016, 4(16): 16-17.
2. 王进, 刘一帆, 王利, 等. 主动脉夹层研究进展. 实用医院临床杂志, 2016, 13(4): 209-212.
3. 赵珺. Stanford B 型主动脉夹层全程腔内根治性修复术: 概念与方案. 中国血管外科杂志: 电子版, 2016, 8(1): 16-19.
4. 戈小虎, 方青波, 管圣, 等. Stanford B 型主动脉夹层的腔内治疗 (附 134 例报告). 中国微创外科杂志, 2012, 12(9): 774-776.
5. 杨洁连, 向定成, 肖华, 等. 急性 Stanford B 型主动脉夹层腔内修复治疗时机与预后的关系. 中国介入心脏病学杂志, 2014(5): 300-303.
6. 陈昭然, 黄毕, 刘斯思, 等. Stanford B 型主动脉夹层临床资料分析. 中国分子心脏病学杂志, 2014(5): 1051-1054.
7. 庞兴学, 王显. 血栓形成的过程与机制研究进展. 医学综述, 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, 樊晓寒, 朱俊, 等. A 型急性主动脉夹层患者血浆 D-二聚体浓度和住院死亡的关系. 中华高血压杂志, 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. 何谦, 古君, 秦超毅, 等. 血小板激活在急性主动脉夹层并发全身炎症反应中的作用. 华西医学, 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

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content