Validation of the Academic Research Consortium High Bleeding Risk Definition in Contemporary PCI Patients
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Bleeding following percutaneous coronary intervention has important prognostic implications. The Academic Research Consortium (ARC) recently proposed a list of clinical criteria to define patients at high bleeding risk (HBR).
OBJECTIVES: This study sought to validate the ARC definition for HBR patients in a contemporary real-world cohort.
METHODS: Patients undergoing coronary stenting between 2014 and 2017 at a tertiary-care center were defined as HBR if they met at least 1 major or 2 minor ARC-HBR criteria. To account for the presence of multiple criteria, patients were further stratified by the number of times they fulfilled the ARC-HBR definition. The primary endpoint was a composite of peri-procedural in-hospital or post-discharge bleeding at 1 year. Secondary endpoints included individual components of the primary bleeding endpoint, myocardial infarction, and all-cause mortality.
RESULTS: Among 9,623 patients, 4,278 (44.4%) qualified as HBR. Moderate or severe anemia was the most common major criterion (33.2%); age ≥75 years was the most frequent minor criterion and the most common overall (46.8%). The rate of the primary bleeding endpoint at 1 year was 9.1% in HBR patients compared with 3.2% in non-HBR patients (p < 0.001), with a stepwise increase in bleeding risk corresponding to the number of times the ARC-HBR definition was fulfilled. HBR patients also experienced significantly higher rates of all secondary endpoints.
CONCLUSIONS: This study validates the ARC-HBR definition in a contemporary group of patients who underwent percutaneous coronary intervention. The ARC-HBR definition identified patients at increased risk not only for bleeding but also for thrombotic events, including all-cause mortality. Coexistence of multiple ARC-HBR criteria showed additive prognostic value.
| Errataetall: |
CommentIn: J Am Coll Cardiol. 2020 Jun 2;75(21):2723-2725. - PMID 32466888 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:75 |
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| Enthalten in: |
Journal of the American College of Cardiology - 75(2020), 21 vom: 02. Juni, Seite 2711-2722 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cao, Davide [VerfasserIn] |
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| Links: |
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| Themen: |
Bleeding |
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| Anmerkungen: |
Date Completed 04.01.2021 Date Revised 04.01.2021 published: Print CommentIn: J Am Coll Cardiol. 2020 Jun 2;75(21):2723-2725. - PMID 32466888 Citation Status MEDLINE |
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| doi: |
10.1016/j.jacc.2020.03.070 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM310474353 |
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| 500 | |a Date Revised 04.01.2021 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: J Am Coll Cardiol. 2020 Jun 2;75(21):2723-2725. - PMID 32466888 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Bleeding following percutaneous coronary intervention has important prognostic implications. The Academic Research Consortium (ARC) recently proposed a list of clinical criteria to define patients at high bleeding risk (HBR) | ||
| 520 | |a OBJECTIVES: This study sought to validate the ARC definition for HBR patients in a contemporary real-world cohort | ||
| 520 | |a METHODS: Patients undergoing coronary stenting between 2014 and 2017 at a tertiary-care center were defined as HBR if they met at least 1 major or 2 minor ARC-HBR criteria. To account for the presence of multiple criteria, patients were further stratified by the number of times they fulfilled the ARC-HBR definition. The primary endpoint was a composite of peri-procedural in-hospital or post-discharge bleeding at 1 year. Secondary endpoints included individual components of the primary bleeding endpoint, myocardial infarction, and all-cause mortality | ||
| 520 | |a RESULTS: Among 9,623 patients, 4,278 (44.4%) qualified as HBR. Moderate or severe anemia was the most common major criterion (33.2%); age ≥75 years was the most frequent minor criterion and the most common overall (46.8%). The rate of the primary bleeding endpoint at 1 year was 9.1% in HBR patients compared with 3.2% in non-HBR patients (p < 0.001), with a stepwise increase in bleeding risk corresponding to the number of times the ARC-HBR definition was fulfilled. HBR patients also experienced significantly higher rates of all secondary endpoints | ||
| 520 | |a CONCLUSIONS: This study validates the ARC-HBR definition in a contemporary group of patients who underwent percutaneous coronary intervention. The ARC-HBR definition identified patients at increased risk not only for bleeding but also for thrombotic events, including all-cause mortality. Coexistence of multiple ARC-HBR criteria showed additive prognostic value | ||
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| 650 | 4 | |a Validation Study | |
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| 650 | 4 | |a bleeding | |
| 650 | 4 | |a coronary artery disease | |
| 650 | 4 | |a percutaneous coronary intervention | |
| 700 | 1 | |a Mehran, Roxana |e verfasserin |4 aut | |
| 700 | 1 | |a Dangas, George |e verfasserin |4 aut | |
| 700 | 1 | |a Baber, Usman |e verfasserin |4 aut | |
| 700 | 1 | |a Sartori, Samantha |e verfasserin |4 aut | |
| 700 | 1 | |a Chandiramani, Rishi |e verfasserin |4 aut | |
| 700 | 1 | |a Stefanini, Giulio G |e verfasserin |4 aut | |
| 700 | 1 | |a Angiolillo, Dominick J |e verfasserin |4 aut | |
| 700 | 1 | |a Capodanno, Davide |e verfasserin |4 aut | |
| 700 | 1 | |a Urban, Philip |e verfasserin |4 aut | |
| 700 | 1 | |a Morice, Marie-Claude |e verfasserin |4 aut | |
| 700 | 1 | |a Krucoff, Mitchell |e verfasserin |4 aut | |
| 700 | 1 | |a Goel, Ridhima |e verfasserin |4 aut | |
| 700 | 1 | |a Roumeliotis, Anastasios |e verfasserin |4 aut | |
| 700 | 1 | |a Sweeny, Joseph |e verfasserin |4 aut | |
| 700 | 1 | |a Sharma, Samin K |e verfasserin |4 aut | |
| 700 | 1 | |a Kini, Annapoorna |e verfasserin |4 aut | |
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