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Comparison of original and modified Academic Research Consortium for High Bleeding Risk definitions in real-world
Kotaro Takahashi1, Katsuya Miura1, Yuki Shima1
1Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
Insights
Simplified High Bleeding Risk (S-HBR) effectively predicts bleeding after percutaneous coronary intervention, similar to the original ARC-HBR definition. Japanese High Bleeding Risk (J-HBR) is also useful for long-term bleeding risk prediction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Risk Stratification
Background:
- High Bleeding Risk (HBR) is crucial in percutaneous coronary intervention (PCI).
- Existing definitions include the Academic Research Consortium for High Bleeding Risk (ARC-HBR).
- Simplified HBR (S-HBR) and Japanese HBR (J-HBR) have been proposed to refine HBR assessment.
Purpose of the Study:
- To compare the diagnostic values of ARC-HBR, S-HBR, and J-HBR.
- To evaluate the predictive accuracy of different HBR definitions for major bleeding events.
- To assess the utility of these definitions at short-term (1 year) and long-term (7 years) post-PCI.
Main Methods:
- Retrospective analysis of 3430 patients undergoing PCI with second-generation drug-eluting stents (2010-2013).
- Evaluation of major bleeding and ischemic events.
- Comparison of diagnostic values using receiver-operating characteristic (ROC) curves.
Main Results:
- Incidence of major bleeding at 7 years: ARC-HBR 10.6%, S-HBR 10.7%, J-HBR 10.0%.
- J-HBR showed lower diagnostic value than ARC-HBR at 1 year (C-statistics 0.64 vs. 0.68).
- S-HBR and J-HBR demonstrated comparable diagnostic values to ARC-HBR for overall bleeding risk prediction.
Conclusions:
- Simplified HBR (S-HBR) is a valuable tool for predicting both short- and long-term bleeding risk, comparable to ARC-HBR.
- Japanese HBR (J-HBR) is also effective for predicting long-term bleeding risk in patients undergoing PCI.
Background:
The Academic Research Consortium for High Bleeding Risk (ARC-HBR) defined high bleeding risk (HBR) in patients undergoing percutaneous coronary intervention. We have reported a simplified HBR (S-HBR), excluding six items with prevalences under 1% from ARC-HBR. The Japanese Circulation Society developed an HBR specific to Japanese (J-HBR), adding three items to ARC-HBR in consideration of ethnicity. Data comparing each HBR are scarce.
Methods:
Patients treated with second-generation drug-eluting stents between January 2010 and December 2013 were enrolled, in whom all items of ARC-HBR, and the incidences of major bleeding and ischemic events were examined. Also, the diagnostic values of ARC-HBR, S-HBR, and J-HBR at 1 and 7 years post procedure were compared by using receiver-operating characteristic curves.
Results:
The study sample consisted of 3430 patients. Mean follow-up period was 2299 ± 904 days. The incidence of major bleeding at 1 and 7 years in each definition was as follows: ARC-HBC, 3.3% and 10.6%; S-HBR, 3.3% and 10.7%; and J-HBR, 2.9% and 10.0%. The diagnostic value of J-HBR for major bleeding at 1 year was lower than that of ARC-HBR (C statistics 0.64 vs. 0.68, p < 0.001). Other diagnostic values of S-HBR and J-HBR were comparable to those of ARC-HBR.
Conclusions:
S-HBR was as useful as ARC-HBR in predicting both short- and long-term HBR, and J-HBR is useful for predicting long-term HBR.
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