<b>The Impact of Thrombocytopenia on PCI Outcomes: A Real-World Data Analysis</b>

Thrombocytopenia (TCP) complicates acute coronary syndrome (ACS) management in patients undergoing percutaneous coronary intervention (PCI). While dual antiplatelet therapy (DAPT) reduces thrombotic events, it also increases bleeding risk, posing a challenge in TCP patients. Current guidelines, including ACC/AHA and ESC recommendations, provide limited guidance on optimal DAPT duration for this population, as risk stratification tools like the PRECISE-DAPT score exclude TCP. This study evaluates TCP’s impact on survival, bleeding, and hospitalization outcomes using real-world data. A retrospective cohort study was conducted using the TriNetX research database. PCI patients were stratified by TCP status, and propensity score matching (PSM) was applied across four models: Minimal Matching, Bleeding Matched (PRECISE-DAPT adjustments), Comorbidity Matched (Charlson Comorbidity Index adjustments), and Double Matched (both). The primary outcome was one-year overall survival; secondary outcomes included bleeding events and hospitalization rates. After PSM, 7,213 TCP+ and 7,213 TCP− patients were included. Mean age ranged from 69.4 to 69.7 years (p = 0.055–0.260), and male representation was 75.2%–76.8% (p = 0.044–0.191). TCP+ patients had significantly lower platelet levels (117.9–118.1 × 10³/μL vs. 230.1–237.9 × 10³/μL, p &lt; 0.001). Despite adjustments, overall survival remained significantly worse for TCP+ patients: HR = 1.818 (p &lt; 0.001, Minimal Matching), HR = 1.636 (p &lt; 0.001, Bleeding Matched), HR = 1.383 (p &lt; 0.001, Comorbidity Matched), and HR = 1.545 (p &lt; 0.001, Double Matched). Bleeding risks were higher in models without bleeding risk adjustments, and hospitalization rates were elevated across most comparisons. These findings suggest TCP is an independent predictor of poor PCI outcomes, persisting even after adjustments for comorbidities and bleeding risk. Further research should refine DAPT strategies and explore systemic vulnerabilities contributing to TCP-related mortality.