Validation of BARC Bleeding Criteria in Patients With Acute Coronary Syndromes
Key result
BARC grade 2-4 bleeding is linked to ~7-fold higher 30-day mortality in NSTE-ACS.
- HR 7.35
- 95% CI 5.59-9.68
- P<0.0001
- n=12,944
Why the study?
The Bleeding Academic Research Consortium (BARC) scale was proposed to standardize bleeding endpoint definitions, but validation in large patient cohorts was needed.
Does bleeding assessed by the BARC scale predict mortality in patients with NSTE-ACS?
Population
12,944 patients with acute coronary syndromes without ST-segment elevation
Comparison
BARC-classified bleeding vs TIMI and GUSTO bleeding scales
Follow-up
Median 502 days
Authors
Discussion
Loading...
Member takes
Implication
Validates BARC as a robust prognostic tool for clinical risk stratification; confirms its utility as a standardized.
Key Points
- To evaluate the association between Bleeding Academic Research Consortium (BARC) bleeding criteria and all-cause mortality, and to compare its prognostic utility against established TIMI and GUSTO bleeding scales.
- Analyzed bleeding outcomes and all-cause mortality in 12,944 patients with non–ST-segment elevation acute coronary syndromes enrolled in the TRACER randomized trial (NCT00527943) over a median follow-up of 502 days.
- Categorized bleeding events using BARC, TIMI (minor/major), and GUSTO (moderate/severe) criteria, evaluating both non-CABG and CABG-related bleeding events.
- Non-CABG bleeding occurred in 15.4% (n=1,998) of patients under BARC (grades 2, 3, or 5), 3.7% (n=484) under TIMI minor/major, and 4.0% (n=514) under GUSTO moderate/severe criteria; CABG-related bleeding (BARC 4) occurred in 1.2% (n=155).
- BARC grades 2, 3, or 4 bleeding were associated with a significantly increased risk of death versus BARC 0 or 1, highest in the first 30 days (HR: 7.35; 95% CI: 5.59 to 9.68; p < 0.0001) and remaining significant up to 1 year, with mortality hazard increasing progressively with higher non-CABG BARC grades.
- BARC 4 bleeding was significantly associated with mortality within 30 days (HR: 10.05; 95% CI: 5.41 to 18.69; p < 0.0001), and adding BARC bleeding to 1-year mortality models provided prognostic improvements comparable to TIMI and GUSTO scales.
Study Design
Type
Cohort (n=12,944)
Structured PICO
Does bleeding assessed by the BARC scale predict mortality in patients with NSTE-ACS?
P
Population
12,944 patients with acute coronary syndromes without ST-segment elevation, followed for a median of 502 days.
E
Exposure
Bleeding assessed by Bleeding Academic Research Consortium (BARC) scale
C
Comparator
Bleeding assessed by TIMI and GUSTO scales
O
Outcome
All-cause deathhard clinical
Main Result
Hazard Ratio: 7.35 (95% CI 5.59–9.68)
p-value: p=< 0.0001
The BARC bleeding scale is significantly associated with subsequent mortality up to 1 year in NSTE-ACS patients, performing comparably to TIMI and GUSTO scales.
Cite This Study
Vranckx et al. (2016) conducted a cohort in Acute coronary syndromes without ST-segment elevation (n=12,944). BARC (2, 3, or 4) bleeding vs. No bleeding (BARC 0 or 1) was evaluated on All-cause death (HR 7.35, 95% CI 5.59-9.68, p=< 0.0001). In patients with NSTE-ACS, BARC grade 2, 3, or 4 bleeding was significantly associated with increased 30-day mortality compared to no bleeding (HR 7.35; 95% CI 5.59-9.68; P<0.0001).