Validation of the Academic Research Consortium High Bleeding Risk Definition in Contemporary PCI Patients

医学 临床终点 经皮冠状动脉介入治疗 传统PCI 心肌梗塞 队列 内科学 急诊医学 心脏病学 临床试验
作者
Davide Cao,Roxana Mehran,George Dangas,Usman Baber,Samantha Sartori,Rishi Chandiramani,Giulio G. Stefanini,Dominick J. Angiolillo,Davide Capodanno,Philip Urban,Marie–Claude Morice,Mitchell W. Krucoff,Ridhima Goel,Anastasios Roumeliotis,Joseph Sweeny,Samin K. Sharma,Annapoorna Kini
出处
期刊:Journal of the American College of Cardiology [Elsevier BV]
卷期号:75 (21): 2711-2722 被引量:171
标识
DOI:10.1016/j.jacc.2020.03.070
摘要

Abstract 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  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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