Post-discharge major bleeding/all-cause death in acute coronary syndrome: academic research consortium criteria versus Japan-specific criteria

BACKGROUND: The differentiation of the Academic Research Consortium high bleeding risk (HBR) (ARC-HBR) criteria and those modified for Japanese patients (J-HBR) for predicting events following discharge in patients with acute coronary syndrome (ACS) has yet to be clarified. In this study, we compared the ARC-HBR and J-HBR criteria for predicting post-discharge bleeding and associated events in patients with ACS. METHODS: We retrospectively analyzed data from 889 patients with ACS discharged alive at two tertiary hospitals in Japan between August 2009 and July 2018. We identified patients with HBR using both sets of criteria. We compared the incidence of major bleeding/all-cause death within 2 years following discharge and performance metrics between each set of criteria, and explored the efficacy of combining both sets of criteria to stratify risk levels for the prediction of clinical events. RESULTS: Eighty patients experienced major bleeding/all-cause death. In the ARC-HBR and J-HBR criteria, 51% and 65% of patients were categorized as HBR, respectively. Both sets of criteria effectively identified patients at a high risk of major bleeding/all-cause death. The ARC-HBR demonstrated a significantly higher area under the curve (AUC) for major bleeding and all-cause death combined (AUC [95% confidence interval]: 0.67 [0.64-0.69]) than that of the J-HBR (0.63 [0.60-0.66], P = 0.015). In each component, while the AUC for major bleeding was comparable between the two sets of criteria (0.61 [0.57-0.64] vs. 0.61 [0.57-0.63], P = 0.95), the ARC-HBR criteria showed a significantly higher AUC for all-cause death than the J-HBR criteria (0.67 [0.64-0.70] vs. 0.61 [0.59-0.64], P < 0.001). The combined use of both sets of criteria effectively stratified the risk for major bleeding/all-cause death (hazard ratio [95% confident interval]: 5.81 [2.79-12.07] in those positive for both sets of criteria, compared to those negative in both sets of criteria). CONCLUSIONS: The ARC-HBR criteria demonstrated a greater discriminative capability for predicting major bleeding/all-cause mortality than the J-HBR criteria. For major bleeding alone, the discriminative ability of both sets of criteria was comparable.