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Predictive Value of the Academic Research Consortium High Bleeding Risk Criteria in Self-Identified Black Individuals
Rebecca M Cohen1, Francesca Maria Di Muro1,2, Samantha Sartori1
1Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
The Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria effectively identify patients at high risk for bleeding and adverse cardiovascular events after percutaneous coronary intervention (PCI), regardless of race. These criteria proved valuable in both Black and White patient populations.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Equity
Background:
- Uncertainty exists regarding the utility of Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria for risk stratification in Black patients undergoing percutaneous coronary intervention (PCI).
- Assessing the predictive performance of ARC-HBR criteria across different racial groups is crucial for equitable patient care.
Purpose of the Study:
- To evaluate the predictive accuracy of the ARC-HBR criteria in stratifying bleeding and thrombotic risk in self-identified Black and White patients undergoing PCI.
- To compare the performance of ARC-HBR criteria between Black and White patient cohorts.
Main Methods:
- Retrospective analysis of 9462 consecutive patients (19.9% Black, 80.1% White) undergoing PCI between 2012-2019.
- Patients were classified as high bleeding risk (HBR) or non-HBR based on ARC-HBR criteria.
- Primary outcome: all-bleeding at 1-year. Secondary outcomes: post-discharge bleeding, major adverse cardiovascular events (MACE), and individual MACE components. Discriminative ability assessed using Harrell's C-index.
Main Results:
- Higher proportion of Black patients (50.8%) compared to White patients (45.6%) classified as HBR, with differing criterion distributions.
- In Black patients, HBR was associated with significantly higher risks of bleeding, MACE, and all-cause mortality.
- In White patients, HBR was significantly associated with higher risks of bleeding and all secondary endpoints. No significant interaction between race and HBR status was observed after multivariable adjustment.
Conclusions:
- The ARC-HBR criteria demonstrate good predictive ability for identifying patients at increased risk of bleeding and thrombotic events post-PCI.
- The criteria's effectiveness in risk stratification is consistent across self-reported Black and White patient populations.
- These findings support the use of ARC-HBR criteria for guiding clinical decisions in diverse patient groups undergoing PCI.
Background:
Whether the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria are a valuable tool for risk stratification in self-identified Black patients undergoing percutaneous coronary intervention (PCI) remains uncertain.
Aims:
This study aims to assess the predictive ability of the ARC-HBR criteria in patients who identify as Black and White.
Methods:
Consecutive patients undergoing PCI at a large tertiary-care center from 2012 to 2019, and self-reporting as Black or White, were included in the current retrospective observational analysis and stratified into HBR and non-HBR based on the ARC-HBR definition. The primary outcome was all-bleeding, defined as a composite of peri-procedural in-hospital and post-discharge bleeding at 1-year follow-up. Secondary outcomes included post-discharge bleeding, major adverse cardiovascular events (MACE)-a composite of all-cause death, myocardial infarction, or stroke- and its individual components. The discriminative ability of the ARC-HBR criteria to predict outcomes was computed using Harrell's C-index.
Results:
Among 9462 patients included, 1881 (19.9%) identified as Black and 7581 (80.1%) as White. In these two groups, 50.8% of Black and 45.6% of White patients were classified as HBR, and a different distribution of the individual major and minor criteria was observed. Within the Black cohort, HBR was associated with a significantly higher risk of the primary bleeding endpoint, MACE, and all-cause mortality, with only a trend toward a higher rate of post-discharge bleeding and MI. Conversely, among White patients, HBR was associated with a significantly higher risk of the primary bleeding endpoint, as well as all secondary endpoints. These findings were confirmed after multivariable adjustment, with no significant interaction between race and HBR status with regard to outcomes.
Conclusions:
In this contemporary PCI registry, the ARC-HBR criteria showed a good ability in identifying patients at increased risk of bleeding and thrombotic events, irrespective of self-reported Black or White race.
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