Temporal Trends of Major Bleeding and Its Prediction by the Academic Research Consortium-High Bleeding Risk Criteria
Sungwook Byun1, Eun Ho Choo2, Gyu-Chul Oh2
1Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
Insights
Major bleeding events in acute myocardial infarction patients undergoing PCI have increased over 10 years. The Academic Research Consortium-High Bleeding Risk criteria accurately predict bleeding, mortality, and ischemic events in these patients.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Limited data exist on temporal trends of major bleeding in acute myocardial infarction (AMI) patients post-percutaneous coronary intervention (PCI).
- The predictive value of Academic Research Consortium-High Bleeding Risk (ARC-HBR) criteria for adverse events in AMI patients requires further investigation.
Purpose of the Study:
- To investigate the 10-year temporal trends of major bleeding (Bleeding Academic Research Consortium [BARC] 3 and 5) in AMI patients undergoing PCI.
- To evaluate the predictive performance of ARC-HBR criteria for major bleeding, mortality, and ischemic events in this population.
Main Methods:
- A multicenter registry analysis of 10,291 AMI patients undergoing PCI between 2004 and 2014.
- Assessment of BARC 3 and 5 bleeding incidence and comparison of outcomes between ARC-defined High Bleeding Risk (HBR) and non-HBR patients at 1 year.
Main Results:
- The annual incidence of BARC 3 and 5 bleeding in AMI patients significantly increased from 1.8% to 5.8% over the study period (p < 0.001).
- ARC-defined HBR patients (32.8%) exhibited significantly higher rates of BARC 3 and 5 bleeding (9.8% vs. 2.9%), all-cause mortality (22.8% vs. 4.3%), and composite ischemic events (22.6% vs. 5.8%) compared to non-HBR patients (p < 0.001 for all).
Conclusions:
- Major bleeding incidence has risen in AMI patients undergoing PCI over the past decade.
- The ARC-HBR criteria effectively predict major bleeding, mortality, and ischemic events in AMI patients, aiding risk stratification.
Abstract:
Limited data exist on the temporal trend of major bleeding and its prediction by the Academic Research Consortium-High Bleeding Risk (ARC-HBR) criteria in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). We investigated 10-year trends of major bleeding and predictive ability of the ARC-HBR criteria in AMI patients. In a multicenter registry of 10,291 AMI patients undergoing PCI between 2004 and 2014 the incidence of Bleeding Academic Research Consortium (BARC) 3 and 5 bleeding was assessed, and, outcomes in ARC-defined HBR patients with AMI were compared with those in non-HBR. The primary outcome was BARC 3 and 5 bleeding at 1 year. Secondary outcomes included all-cause mortality and composite of cardiovascular death, myocardial infarction, or ischemic stroke. The annual incidence of BARC 3 and 5 bleeding in the AMI population has increased over the years (1.8% to 5.8%; p < 0.001). At 1 year, ARC-defined HBR (n = 3371, 32.8%) had significantly higher incidence of BARC 3 and 5 bleeding (9.8% vs. 2.9%; p < 0.001), all-cause mortality (22.8% vs. 4.3%; p < 0.001) and composite of ischemic events (22.6% vs. 5.8%; p < 0.001) compared to non-HBR. During the past decade, the incidence of major bleeding in the AMI population has increased. The ARC-HBR criteria provided reliable predictions for major bleeding, mortality, and ischemic events in AMI patients.
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