Key result
ARC-HBR status in AMI is linked to ~3-fold higher MACE and major bleeding risks.
Why the study?
A significant proportion of AMI patients have high-bleeding-risk characteristics, but their influence on ischaemic and bleeding events in AMI all-comers is not well described.
Does high bleeding risk (HBR) status according to ARC-HBR criteria predict major bleeding and ischemic events in an all-comer AMI population?
Does high bleeding risk (HBR) status according to ARC-HBR criteria predict major bleeding and ischemic events in an all-comer AMI population?
The ARC-HBR criteria effectively identify AMI patients at significantly increased risk for both major bleeding and ischemic events, regardless of whether they are managed medically or invasively.
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ARC-HBR criteria may aid AMI risk stratification; extends validation to all-comers yet leaves therapeutic impact open.
Background A significant proportion of acute myocardial infarction (AMI) patients have characteristics of high-bleeding -risk (HBR). Their influence on ischaemic and bleeding-events in AMI all-comers is not well described. Methods AMI Patients in England and Wales (E&W), and Sweden between 2005 and 2019 were included from MINAP and SWEDEHEART national registries. Patients were categorised according to the Academic Research Consortium for HBR criteria (ARC-HBR). Primary outcomes were adjusted risk of major adverse cardiovascular events (MACE; admission with reinfarction and cardiovascular death) and major-bleeding events (death or readmission with bleeding), secondary outcomes were all-cause and cardiovascular mortality, up-to five-years, with Cox-regression models, adjusted for baseline demographics. Secondary analyses evaluated medically and invasively-managed patients. Results 563,251 AMI patients from E&W (39% HBR, median follow-up 1901 days) and 189,102 from Sweden (39% HBR, 2084 days) were included. Risk of MACE (E&W: adjusted Hazard ratio (aHR) 2.99, 95% CI [2.95-3.02], Sweden: 2.68[2.64-2.73]) and major- bleeding events (E&W: 2.28[2.21-2.35], Sweden: 2.71[2.58-2.85]) was higher in HBR-patients (all P<0.001). MACE was more likely in medically-managed (E&W: 3.24[3.19-3.29], Sweden: 2.31 [2.26-2.37]) and invasively-managed (E&W: 2.94[2.88-3.00], Sweden: 1.98[1.92-2.04]) HBR-patients (both P<0.001), as were major-bleeding events; medical (E&W: 2.28[2.19-2.37], Sweden: 1.35[1.25-1.45]) (both P<0.001); invasive groups (E&W: 2.25[2.15-2.35], P<0.001), Sweden: 1.41[1.29-1.54], P=0.024). Conclusions In an all-comer AMI population, 1 in 3 meet HBR criteria. HBR patients had significantly higher rates of MACE and major bleeding, persisting whether managed invasively or medically. We show that the ARC-HBR criteria are associated with increased bleeding and MACE risk in all-comer AMI patients.
Weight et al. (2026) studied this question. ARC-HBR criteria identified 39% AMI patients as high bleeding risk, who had 2.7-3.0-fold higher MACE and 2.3-2.7-fold higher major bleeding risks over ~5 years.
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