BARC type 3b or 3c bleeding and TIMI major bleeding conferred a 2-fold higher risk of 1-year mortality in STEMI patients (HR 1.84; 95% CI 1.23-2.77 and HR 2.00; 95% CI 1.32-3.01, respectively).
Cohort (n=2,002)
Does the BARC bleeding classification predict 1-year mortality in STEMI patients undergoing primary PCI compared to existing bleeding definitions?
Both BARC and TIMI bleeding classifications effectively identify STEMI patients at increased risk of 1-year mortality following primary PCI.
Hazard Ratio: 1.84 (95% CI 1.23–2.77)
OBJECTIVES: The aim of the present analysis was to compare 1-year mortality prediction of Bleeding Academic Research Consortium (BARC)-defined bleeding complications with existing bleeding definitions in patients with ST-segment elevation myocardial infarction (STEMI) and to investigate the prognostic value of the individual data elements of the bleeding classifications for 1-year mortality. BACKGROUND: BARC recently proposed a novel standardized bleeding definition. METHODS: The in-hospital occurrence of bleeding defined according to the BARC, TIMI (Thrombolysis In Myocardial Infarction), GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries), and ISTH (International Society on Thrombosis and Haemostasis) bleeding classifications was assessed in 2,002 STEMI patients undergoing primary percutaneous coronary intervention between January 1, 2003, and July 31, 2008. RESULTS: BARC types 2, 3, 4, and 5 bleeding occurred in 4.4%, 14.2%, 1.4%, and 0.3% of patients, respectively. By multivariable analysis, GUSTO- and ISTH-defined bleeding was not significantly associated with 1-year mortality, whereas TIMI major and BARC type 3b or 3c bleeding conferred a 2-fold higher risk of 1-year mortality (hazard ratios HRs: 2.00 95% confidence interval (CI): 1.32 to 3.01 and 1.84 95% CI: 1.23 to 2.77, respectively). Data elements most strongly associated with mortality were a hemoglobin decrease ≥5 g/dl (HR: 1.94 95% CI: 1.26 to 2.98), the use of vasoactive agents for bleeding (HR: 2.01 95% CI: 0.91 to 4.44), cardiac tamponade (HR: 2.38 95% CI: 0.56 to 10.1), and intracranial hemorrhage (HRs for 1-year mortality were not computable because there was only 1 patient with intracranial bleeding). CONCLUSIONS: Both the BARC and TIMI bleeding classification identified STEMI patients at risk of 1-year mortality.
Kikkert et al. (Fri,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=2,002). BARC type 3b or 3c bleeding vs. No bleeding / other bleeding definitions was evaluated on 1-year mortality (HR 1.84, 95% CI 1.23 to 2.77). BARC type 3b or 3c bleeding and TIMI major bleeding conferred a 2-fold higher risk of 1-year mortality in STEMI patients (HR 1.84; 95% CI 1.23-2.77 and HR 2.00; 95% CI 1.32-3.01, respectively).