Background Patients undergoing percutaneous coronary intervention (PCI) are at risk of developing bleeding and/or thrombotic complications. Identification and quantification of the difference in risk may impact on management decisions. The aim of this study was to 1) classify patients based on their bleeding risk 2) quantify and compare clinical outcomes following PCI based on the bleeding risk phenotype and 3) assess the value of a bleeding versus thrombotic risk trade-off calculator for those at high bleeding risk (HBR). Methods Single centre one-year retrospective review of consecutive patients undergoing PCI (2002). HBR was defined as per the Academic Research Consortium for High Bleeding Risk (ARC-HBR). The ARC-HBR trade-off model was applied to calculate the thrombotic versus bleeding risk in HBR patients. Bleeding ARC 3 or 5, acute coronary syndrome and all-cause mortality data was obtained over a median 30 (IQR 27–33) month follow-up. Results 404 patients, median age 68 (IQR 61–76) years, 75% male. 40% (162/404) were HBR. There was a 7% (29/404) mortality rate, 6% (26/404) BARC 3 or 5 rate and a 3% (13/404) thrombotic rate. A HBR phenotype conferred a greater risk of bleeding and all-cause mortality, log-rank P PPP= .1. The ARC-HBR trade off calculator did not predict those HBR patients at higher thrombotic risk, with no difference in thrombotic events between groups. Conclusions A high proportion of patients in a contemporary NHS cohort were identified as HBR. This conferred a greater risk of bleeding and all-cause mortality with no difference in thrombotic outcomes. The trade-off calculator overestimated thrombotic risk. Prioritisation should be given to identifying and managing HBR patients more effectively.
Murphy et al. (Wed,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: