Limited Impact of High Bleeding Risk Calculation and Peri-Procedural Discussion on Dual-Antiplatelet Therapy Duration and Clinical Outcomes After Percutaneous Coronary Intervention

Background: The Japanese version of the high bleeding risk (J-HBR) criteria identifies patients with HBR undergoing percutaneous coronary intervention (PCI). We evaluated whether routine J-HBR calculation and peri-procedural discussion on dual-antiplatelet therapy (DAPT) duration were associated with changes in DAPT practice and clinical outcomes. Methods and Results: We retrospectively evaluated 793 patients who underwent PCI between August 2019 and August 2021. Routine J-HBR calculation and peri-procedural discussion on DAPT duration were introduced in August 2020, and patients were categorized into post- and pre-J-HBR groups. The median DAPT duration was 174 and 188 days (P=0.47), and guideline-directed DAPT duration was achieved in 62.6% and 56.9%, respectively (P=0.13) in the post- and pre-J-HBR groups. Clinical outcomes did not differ significantly between groups, including net adverse clinical events (hazard ratio [HR], 1.08; 95% confidence interval [CI], 0.77–1.52; P=0.65), major cardiovascular or cerebrovascular events (HR, 0.76; 95% CI, 0.44–1.32; P=0.34), and major bleeding (HR, 1.30; 95% CI, 0.90–1.89; P=0.17). Multivariable Cox proportional hazards analysis showed that routine J-HBR calculation and peri-procedural discussion were not associated with a significant reduction in major bleeding (HR, 0.97; 95% CI, 0.65–1.46; P=0.88). Conclusions: Routine J-HBR calculation and peri-procedural discussion on DAPT duration were not associated with significant changes in overall DAPT duration or clinical outcomes.