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Published on: March 15, 2022
Impact of clinical presentation on bleeding risk after percutaneous coronary intervention and implications for the
Felice Gragnano1, Alessandro Spirito, Noé Corpataux
1Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland.
Insights
Patients presenting with acute coronary syndrome (ACS) face a higher risk of major bleeding after percutaneous coronary intervention (PCI). The Academic Research Consortium (ARC) High Bleeding Risk (HBR) criteria showed lower accuracy in ACS patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Risk Stratification
Background:
- Identifying bleeding risk factors is crucial for managing patients undergoing percutaneous coronary intervention (PCI).
- The impact of clinical presentation on post-PCI bleeding risk remains unclear.
Purpose of the Study:
- To determine if clinical presentation influences bleeding risk in PCI patients.
- To evaluate the consistent performance of Academic Research Consortium (ARC) High Bleeding Risk (HBR) criteria in acute (ACS) and chronic (CCS) coronary syndrome.
Main Methods:
- Analysis of consecutive patients from the Bern PCI Registry.
- Stratification by clinical presentation (ACS vs. CCS).
- Comparison of one-year bleeding events and assessment of ARC-HBR criteria performance.
Main Results:
- Among 16,821 patients, ACS presentation was associated with a higher one-year risk of BARC 3 or 5 bleeding (4.97% vs. 3.60%).
- Adjusted analysis confirmed ACS as a predictor of increased bleeding risk, primarily non-access site-related and within 30 days.
- ARC-HBR criteria demonstrated lower discrimination in ACS patients compared to CCS patients.
Conclusions:
- Acute coronary syndrome presentation independently predicts one-year major bleeding risk following PCI.
- The ARC-HBR score's predictive performance is diminished in ACS patients.
- Incorporating ACS as a minor criterion may improve the ARC-HBR score's utility.
Background:
The identification of bleeding risk factors in patients undergoing percutaneous coronary intervention (PCI) is essential to inform subsequent management. Whether clinical presentation per se affects bleeding risk after PCI remains unclear.
Aims:
We aimed to assess whether clinical presentation per se predisposes to bleeding in patients undergoing PCI and if the Academic Research Consortium (ARC) High Bleeding Risk (HBR) criteria perform consistently in acute (ACS) and chronic (CCS) coronary syndrome patients.
Methods:
Consecutive patients undergoing PCI from the Bern PCI Registry were stratified by clinical presentation. Bleeding events at one year were compared in ACS versus CCS patients, and the originally defined ARC-HBR criteria were assessed.
Results:
Among 16,821 patients, 9,503 (56.5%) presented with ACS. At one year, BARC 3 or 5 bleeding occurred in 4.97% and 3.60% of patients with ACS and CCS, respectively. After adjustment, ACS remained associated with higher BARC 3 or 5 bleeding risk (adjusted HR 1.21, 95% CI: 1.01-1.43; p=0.034), owing to non-access site-related occurrences, which accrued mainly within the first 30 days after PCI. The ARC-HBR score had lower discrimination among ACS compared with CCS patients, and its performance slightly improved when ACS was computed as a minor criterion.
Conclusions:
ACS presentation per se predicts one-year major bleeding risk after PCI. The ARC-HBR score discrimination appeared lower in ACS than CCS, and its overall performance improved numerically when ACS was computed as an additional minor risk criterion.
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