Key result
High bleeding risk (ARC-HBR) patients undergoing PCI had higher rates of BARC 3-5 bleeding (10.5% vs 1.5%, p<0.01) and POCE (27.4% vs 18.2%, p<0.01) at 2 years compared to low-risk patients.
Why the study?
The Academic Research Consortium proposed standardized criteria for High Bleeding Risk (ARC-HBR), prompting the need to evaluate ischemic and hemorrhagic outcomes using this definition in real-world PCI patients.
Does high bleeding risk according to ARC-HBR criteria predict increased bleeding and ischemic events in patients undergoing percutaneous coronary intervention?
Cohort (n=1,080)
Does high bleeding risk according to ARC-HBR criteria predict increased bleeding and ischemic events in patients undergoing percutaneous coronary intervention?
Absolute Event Rate: 10.5% vs 1.5%
p-value: p=<0.01
The ARC-HBR criteria effectively identify patients at higher risk for both major bleeding and ischemic events at 2 years following percutaneous coronary intervention.
ARC-HBR criteria identify higher bleeding and ischemic risk post-PCI; supports validation but leaves open whether it should guide therapy in routine practice.
Background: The Academic Research Consortium have identified a set of major and minor risk factors in order to standardize the definition of a High Bleeding Risk (ACR-HBR). Aims: The aim of this study is to stratify the bleeding risk in patients included in the Cardio-Fribourg registry, according to the Academic Research Consortium for High Bleeding Risk (ACR-HBR) definition, and to report ischemic and hemorrhagic events at 2-year of clinical follow-up. Methods: Between 2015 and 2017, consecutive patients undergoing percutaneous coronary intervention were prospectively included in the Cardio-Fribourg registry. Patients were considered high (HBR) or low (LBR) bleeding risk depending on the ARC-HBR definition. Primary endpoints were hierarchical major bleeding events as defined by the Bleeding Academic Research Consortium (BARC) grade 3–5, and ARC patient-oriented major adverse cardiac events (POCE) at 2-year follow-up. Results: Follow-up was complete in 1,080 patients. There were 354 patients in the HBR group (32.7%) and 726 patients in the low-bleeding risk (LBR) group (67.2%). At 2-year follow-up, cumulative BARC 3–5 bleedings were higher in HBR (10.5%) compared to LBR patients (1.5%, p < 0.01) and the impact of HBR risk factors was incremental. At 2-year follow-up, POCE were more frequent in HBR (27.4%) compared to LBR group (18.2%, <0.01). Overall mortality was higher in HBR (14.0%) vs. LBR (2.9%, p < 0.01). Conclusions: ARC-HBR criteria appropriately identified a population at a higher risk of bleeding after percutaneous coronary intervention. An increased risk of bleeding is also associated with an increased risk of ischemic events at 2-year follow-up.
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Doomun et al. (2021) conducted a cohort in percutaneous coronary intervention (n=1,080). High Bleeding Risk (ARC-HBR) vs. Low Bleeding Risk (LBR) was evaluated on hierarchical major bleeding events (BARC grade 3-5) (p=<0.01). High bleeding risk (ARC-HBR) patients undergoing PCI had higher rates of BARC 3-5 bleeding (10.5% vs 1.5%, p<0.01) and POCE (27.4% vs 18.2%, p<0.01) at 2 years compared to low-risk patients.
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