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Validation of the Academic Research Consortium High Bleeding Risk Definition in Contemporary PCI Patients

2020; Elsevier BV; Volume: 75; Issue: 21 Linguagem: Inglês

10.1016/j.jacc.2020.03.070

1558-3597

Davide Cao, Roxana Mehran, George Dangas, Usman Baber, Samantha Sartori, Rishi Chandiramani, Giulio Stefanini, Dominick J. Angiolillo, Davide Capodanno, Philip Urban, Marie‐Claude Morice, Mitchell W. Krucoff, Ridhima Goel, Anastasios Roumeliotis, Joseph Sweeny, Samin K. Sharma, Annapoorna Kini,

Coronary Interventions and Diagnostics

Bleeding following percutaneous coronary intervention has important prognostic implications. The Academic Research Consortium (ARC) recently proposed a list of clinical criteria to define patients at high bleeding risk (HBR). This study sought to validate the ARC definition for HBR patients in a contemporary real-world cohort. Patients undergoing coronary stenting between 2014 and 2017 at a tertiary-care center were defined as HBR if they met at least 1 major or 2 minor ARC-HBR criteria. To account for the presence of multiple criteria, patients were further stratified by the number of times they fulfilled the ARC-HBR definition. The primary endpoint was a composite of peri-procedural in-hospital or post-discharge bleeding at 1 year. Secondary endpoints included individual components of the primary bleeding endpoint, myocardial infarction, and all-cause mortality. Among 9,623 patients, 4,278 (44.4%) qualified as HBR. Moderate or severe anemia was the most common major criterion (33.2%); age ≥75 years was the most frequent minor criterion and the most common overall (46.8%). The rate of the primary bleeding endpoint at 1 year was 9.1% in HBR patients compared with 3.2% in non-HBR patients (p < 0.001), with a stepwise increase in bleeding risk corresponding to the number of times the ARC-HBR definition was fulfilled. HBR patients also experienced significantly higher rates of all secondary endpoints. This study validates the ARC-HBR definition in a contemporary group of patients who underwent percutaneous coronary intervention. The ARC-HBR definition identified patients at increased risk not only for bleeding but also for thrombotic events, including all-cause mortality. Coexistence of multiple ARC-HBR criteria showed additive prognostic value.