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Validation of the Academic Research Consortium High Bleeding Risk Definition in Contemporary PCI Patients
Davide Cao1, Roxana Mehran2, George Dangas2
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Insights
The Academic Research Consortium (ARC) high bleeding risk (HBR) definition accurately identifies patients undergoing percutaneous coronary intervention at increased risk for bleeding and mortality. Multiple HBR criteria indicate additive prognostic value.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Risk Stratification
Background:
- Bleeding after percutaneous coronary intervention (PCI) significantly impacts patient prognosis.
- The Academic Research Consortium (ARC) developed clinical criteria to identify patients at high bleeding risk (HBR).
Purpose of the Study:
- To validate the ARC-HBR definition in a contemporary, real-world patient cohort undergoing coronary stenting.
- To assess the prognostic implications of the ARC-HBR definition beyond bleeding events.
Main Methods:
- A cohort of 9,623 patients undergoing coronary stenting (2014-2017) was analyzed.
- Patients were classified as HBR based on ARC criteria (≥1 major or ≥2 minor).
- Primary endpoint: composite bleeding at 1 year; secondary endpoints: myocardial infarction, all-cause mortality.
Main Results:
- 44.4% of patients met HBR criteria; anemia and age ≥75 were most common.
- HBR patients had significantly higher 1-year bleeding rates (9.1% vs. 3.2%) compared to non-HBR.
- A stepwise increase in bleeding risk was observed with more fulfilled HBR criteria; HBR also linked to higher mortality.
Conclusions:
- The ARC-HBR definition is validated in a contemporary PCI cohort.
- ARC-HBR identifies patients at elevated risk for bleeding, thrombotic events, and mortality.
- Multiple HBR criteria demonstrate additive prognostic value for adverse outcomes.
Background:
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).
Objectives:
This study sought to validate the ARC definition for HBR patients in a contemporary real-world cohort.
Methods:
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.
Results:
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.
Conclusions:
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.
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