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Predictive Ability of the Academic Research Consortium High Bleeding Risk Criteria in Patients Undergoing
Michael Gao1, Alessandro Spirito1, Samantha Sartori1
1Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
The Academic Research Consortium (ARC) high bleeding risk (HBR) criteria consistently predict major bleeding risk in patients undergoing percutaneous coronary intervention (PCI) across all body mass index (BMI) categories. This finding supports the use of HBR criteria in diverse patient populations.
Area of Science:
- Cardiology
- Clinical Research
- Obesity Medicine
Background:
- The predictive accuracy of the Academic Research Consortium (ARC) high bleeding risk (HBR) criteria across varying body mass index (BMI) categories after percutaneous coronary intervention (PCI) is not well-established.
- Understanding this relationship is crucial for risk stratification and management of patients undergoing PCI.
Purpose of the Study:
- To evaluate the consistency of the ARC-HBR criteria's predictive ability for major bleeding in patients stratified by BMI categories.
- To assess the association between ARC-HBR criteria and 1-year major bleeding rates across different BMI groups.
Main Methods:
- A cohort of 16,123 patients undergoing PCI between 2012 and 2019 was analyzed.
- Patients were categorized into five BMI groups: normoweight, overweight, and Class I, II, and III obesity.
- The primary outcome was major bleeding at 1 year post-PCI, with analysis stratified by BMI and HBR status.
Main Results:
- Major bleeding rates at 1 year varied across BMI categories, with normoweight patients experiencing 6% bleeding.
- Overweight and obese patients (Class I, II, III) showed bleeding rates ranging from 3.5% to 4.9%.
- The ARC-HBR criteria were consistently associated with increased major bleeding risk (>4% at 1 year) across all BMI categories, with at least a twofold risk increase.
Conclusions:
- The presence of ARC-HBR criteria reliably predicts a significantly increased risk of major bleeding.
- This predictive ability remains consistent across all evaluated body mass index categories in patients undergoing PCI.
Background:
Whether the high bleeding risk (HBR) criteria of the Academic Research Consortium (ARC) have a consistent predictive ability across different categories of body mass index (BMI) remains unclear.
Methods:
Consecutive patients undergoing percutaneous coronary intervention (PCI) between 2012 and 2019 at Mount Sinai Hospital (New York, USA) were stratified into five BMI categories (18.5-24.9 kg/m2 [normoweight], 25-29.9 kg/m2 [overweight], 30-34.9 kg/m2 [Class I obesity], 35-39.9 kg/m2 [Class II obesity], and BMI ≥ 40 kg/m2 [Class III obesity]) and by HBR status. The primary outcome was major bleeding at 1 year after PCI.
Results:
Among 16,123 patients, normoweight, overweight, class I, class II, and class III obesity were found in 23.7%, 41%, 24.5%, 9.3%, 4.8% of patients, respectively. Fulfillment of the ARC-HBR criteria ranged between 34.4% and 48.5% across these BMI categories. One-year rates of major bleeding was 6% in normoweight patients (reference), 4.1% in overweight (adj.HR 0.73, 95% CI 0.60-0.88), 3.5% in class I (adj.HR 0.62, 95% CI 0.49-0.77), 4.2% in class II (adj.HR 0.72, 95% CI 0.54-0.96), and 4.9% in class III (adj.HR 0.83, 95% CI 0.58-1.18) obesity. Consistently across the 5 BMI categories, the fulfillment of ARC-HBR criteria was related with > 4% rates of major bleeding at 1-year and with ≥ 2 times risk increase of major bleeding (pint = 0.177).
Conclusions:
The presence of the ARC-HBR criteria predicted a significantly increased risk of major bleeding consistently in each BMI category.
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