Annual vascular and bleeding outcomes in East Asian poststenting patients with acute coronary syndrome: The BRIC-ACS II trial

Funding Acknowledgements Type of funding sources: None. Main funding source(s): no Objective We aim to determine the incidence of events in the ‘real-world’ ACS Chinese patients over 1-year after PCI. Methods and Results From November 2017 till April 2020, we enrolled post-stenting ACS patients (n=5515) from 30 hospitals with the strict 1-year follow-up (n=5150). Only 153(3.0%) patients developed MACE (a composite of all-cause death, myocardial infarction, ischemic stroke, or urgent coronary revascularization). The cumulative incidence of annual bleeding (BARC≥2) was 5.8% (298/5150). The BARC≥2 bleeding was higher 298 (5.8%) and was not associated with worsened MACE (P =0.52). Patients treated with ticagrelor (n=1620, 6.0%) had a significantly increased risk of bleeding than those treated with clopidogrel (n=2331; 4.1%) (HR=1.486; 95% CI:1.12-1.97; P=0.006), but similar risk of vascular MACE (2.7% vs 2.8%; HR= 0.94; 95% CI:0.64-1.38; P=0.747).The factors independently associated with the comprehensive risk of BARC≥2 bleeding and MACE, including female gender, renal insufficiency, peptic ulcer, atrial fibrillation, continuous use of ticagrelor and non-continuous DAPT. The discrimination of the nomogram model was further tested by the ROC curve (AUC value:0.610 (95% CI, 0.577-0.642)). Conclusions The annual incidence of BARC≥2 bleeding in ACS patients treated with PCI in China was higher (5.8%) than MACE (3.0%). DAPT with ticagrelor increased the bleeding rates with no trend towards MACE reduction.