Key result
Combining GRACE score and ARC-HBR criteria improves post-PCI STEMI bleeding prediction to an AUC of ~0.77.
Why the study?
To evaluate the incremental predictive value of combining the GRACE score with the ARC-HBR criteria for predicting bleeding risk after PCI in patients with STEMI.
Does the combination of the GRACE score and ARC-HBR criteria improve the prediction of post-PCI bleeding in STEMI patients compared to using either score alone?
Observational (n=338)
No
Does the combination of the GRACE score and ARC-HBR criteria improve the prediction of post-PCI bleeding in STEMI patients compared to using either score alone?
Effect estimate: AUC 0.774 (95% CI 0.726-0.818)
Absolute Event Rate: 0.774% vs 0.712%
Combining the GRACE score and ARC-HBR criteria significantly improves predictive discrimination for post-PCI bleeding in STEMI patients, offering a superior tool for guiding individualized antithrombotic therapy.
May aid post-PCI bleeding risk stratification in STEMI; extends GRACE and ARC-HBR but remains hypothesis-generating.
Objective: To evaluate the incremental predictive value of the Global Registry of Acute Coronary Events (GRACE) score combined with the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria for bleeding risk after percutaneous coronary intervention (PCI) in patients with ST‑segment elevation myocardial infarction (STEMI). Methods: This prospective observational study enrolled 338 STEMI patients who underwent their first PCI at Fuyang People's Hospital from January 2023 to March 2024. Bleeding events were defined according to the Bleeding Academic Research Consortium (BARC) types 1-5. Patients were stratified by GRACE score (low/middle/high) and ARC‑HBR status (high/low). The predictive performance of the model was assessed using receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), integrated discrimination improvement (IDI), decision curve analysis (DCA), and calibration plots. Internal validation was performed via bootstrap resampling (1,000 iterations). Results: =3.568, P=0.8938). Bootstrap internal validation produced a bias‑corrected AUC of 0.775. Conclusion: Compared with either score alone, the combination of the GRACE score and the ARC-HBR criteria provides incremental predictive value for post-PCI bleeding in STEMI patients.
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Wang et al. (2026) conducted an observational in STEMI patients undergoing first PCI (n=338). Combination of GRACE score and ARC-HBR criteria vs. GRACE score alone or ARC-HBR criteria alone was evaluated on Occurrence of bleeding events (in-hospital or within one year post-discharge) (AUC 0.774, 95% CI 0.726-0.818). The combination of the GRACE score and ARC-HBR criteria improved the prediction of post-PCI bleeding in STEMI patients compared to either score alone, achieving an AUC of 0.774.
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