Patients meeting the ARC-HBR definition had significantly higher rates of bleeding at 1 year compared to non-HBR patients (9.1% vs 3.2%, p<0.001).
Cohort (n=9,623)
No
Does the Academic Research Consortium (ARC) High Bleeding Risk (HBR) definition accurately predict 1-year bleeding and thrombotic events in patients undergoing percutaneous coronary intervention?
The ARC-HBR definition effectively stratifies bleeding and thrombotic risk in contemporary PCI patients, with additive prognostic value when multiple criteria are met.
Absolute Event Rate: 9.1% vs 3.2%
p-value: p=<0.001
BACKGROUND Bleeding following percutaneous coronary intervention has important prognostic implications. The Academic Research Consortium (ARC) recently proposed a list of clinical criteria to define patients at high bleeding risk (HBR). OBJECTIVES This study sought to validate the ARC definition for HBR patients in a contemporary real-world cohort. METHODS Patients undergoing coronary stenting between 2014 and 2017 at a tertiary-care center were defined as HBR if they met at least 1 major or 2 minor ARC-HBR criteria. To account for the presence of multiple criteria, patients were further stratified by the number of times they fulfilled the ARC-HBR definition. The primary endpoint was a composite of peri-procedural in-hospital or post-discharge bleeding at 1 year. Secondary endpoints included individual components of the primary bleeding endpoint, myocardial infarction, and all-cause mortality. RESULTS Among 9,623 patients, 4,278 (44.4%) qualified as HBR. Moderate or severe anemia was the most common major criterion (33.2%); age ≥75 years was the most frequent minor criterion and the most common overall (46.8%). The rate of the primary bleeding endpoint at 1 year was 9.1% in HBR patients compared with 3.2% in non-HBR patients (p < 0.001), with a stepwise increase in bleeding risk corresponding to the number of times the ARC-HBR definition was fulfilled. HBR patients also experienced significantly higher rates of all secondary endpoints. CONCLUSIONS This study validates the ARC-HBR definition in a contemporary group of patients who underwent percutaneous coronary intervention. The ARC-HBR definition identified patients at increased risk not only for bleeding but also for thrombotic events, including all-cause mortality. Coexistence of multiple ARC-HBR criteria showed additive prognostic value.
Cao et al. (Mon,) conducted a cohort in Patients undergoing coronary stenting (PCI) (n=9,623). High Bleeding Risk (HBR) status per ARC definition vs. Non-HBR status was evaluated on Composite of peri-procedural in-hospital or post-discharge bleeding at 1 year (p=<0.001). Patients meeting the ARC-HBR definition had significantly higher rates of bleeding at 1 year compared to non-HBR patients (9.1% vs 3.2%, p<0.001).