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High Plateletcrit Is Associated with Poor Primary Patency After Open and Endovascular Interventions for Chronic Limb Ischemia

Nader Djalal Nader1, Leili Pourafkari1, Hasan Haldun Dosluoglu2, Sikandar Zaman Khan2

1Department of Anesthesiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
2Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York

BACKGROUND AND AIM: Plateletcrit (PCT) is a marker of total platelet mass and easily be calculated from a complete blood count (CBC). High PCT has been reported to be associated with restenosis after coronary interventions. However, its association with peripheral interventions is unknown. We looked at the effect of PCT on patency of endovascular and open interventions for chronic limb ischemia.

METHODS: Patients who underwent revascularization for chronic limb ischemia (Rutherford 3-6) between 06/2001-12/2014 were retrospectively identified. Based on preoperative PCT, patients were divided into tertiles- low (0.046-0.211), medium (0.212-0.271) and high (0.272-0.842) PCT groups. Primary patency was calculated using Kaplan-Meier and compared with Log-rank. Cox regression was used for multivariate analysis.

RESULTS: A total of 1431 patients were identified and divided into low (477), medium (477) and high (477) PCT groups. Median (range) age was 66 (60-75) years in the high-PCT was compared to 67 (61-76) years and 69 (63-79) years in the medium and low-PCT groups (P=.009). Coronary artery disease and congestive heart failure were more prevalent in the low-PCT group compared to other groups (CAD, 62% vs 51% and 50%, P<0.001; CHF 13% vs. 7%, 7%, P<0.001). The antiplatelet use was similar between groups. Five-year primary patency was significantly higher in the low-PCT group (65±3% vs. 55±3% and 51±3% in the medium and high-PCT groups (P=0.005) (Figure) Multivariate regression analysis showed that CLI (HR 1.7 (1.3-2.2), P<0.001) and low-PCT (HR 0.6 (0.5-0.9), P=.007) were independently associated loss of primary patency (Table).

CONCLUSIONS: High PCT is associated with decreased primary patency as compared to low PCT after open and endovascular interventions for chronic limb ischemia. Patients with high PCT values might benefit from an intensified antiplatelet therapy after interventions.

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