Prognostic Value of BARC-defined Bleeding in East Asian Acute Myocardial Infarction Patients: Evidence from Multicentre Registries in Korea and Japan

Abstract The Bleeding Academic Research Consortium (BARC) classification was proposed to standardize bleeding endpoint definitions and reports in cardiovascular clinical trials. However, its prognostic value has not been fully validated in East Asian patients with acute myocardial infarction (AMI) who have a higher bleeding risk than Western populations do. We analyzed bleeding events (types 2 or 3) based on the BARC classification in 13,657 patients with AMI (mean age 64.9 ± 12.7 years) from nationwide prospective registries in Japan and Korea. The primary endpoint was all-cause mortality during the 1-year clinical follow-up. During the 1-year follow-up, BARC type 2 or 3 bleeding occurred in 5.5% of the patients (n = 759). Patients who experienced BARC type 2 or 3 bleeding had a significantly higher risk of mortality compared with those without bleeding (hazard ratio HR 4.1, 95% confidence interval CI 3.4–4.8, p < 0.001). The risk of mortality was higher in BARC type 3 (HR 6.4, 95% CI 5.1–7.9) than in type 2 bleeding (HR 2.4, 95% CI 1.8–3.1). BARC type 2 or 3 bleeding remained significantly associated with increased mortality after adjustment (adjusted HR 1.9, 95% CI 1.5–2.5, p < 0.001). Similar associations with mortality were observed when each BARC classification (type 2 and 3) was analyzed individually. In East Asian patients with AMI, BARC-defined bleeding events were significantly associated with increased mortality. These findings support the adoption of the BARC classification to predict mortality, particularly in East Asian patients with AMI.