The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Impact of Clinical Presentation on Bleeding Risk after Percutaneous Coronary Intervention and Implications for the ARC-HBR Definition

DOI: 10.4244/EIJ-D-21-00181

1. Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland; Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Caserta, Italy
2. Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
3. Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland; University Heart Center Freiburg–Bad Krozingen, Bad Krozingen, Germany
4. Department of Cardiology, Inselspital, Bern University Hospital, Bern
5. Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
6. Cardio-Thoracic-Vascular Department, Centro Alte Specialità e Trapianti, Catania, Italy and Azienda Ospedaliero Universitaria Policlinico “G. Rodolico – San Marco”, University of Catania, Italy
7. La Tour Hospital, Geneva, Switzerland
8. London School of Hygiene and Tropical Medicine, UK
9. Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
10. Clinical Trials Unit (CTU) Bern, University of Bern, Bern, Switzerland
11. Department of Cardiology, Inselspital, Bern, University Hospital, Bern, Switzerland; Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland., Switzerland

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Background: The identification of bleeding risk factors in patients undergoing percutaneous coronary intervention (PCI) is essential to inform subsequent management. Whether clinical presentation per se affects bleeding risk after PCI remains unclear.

Aims: We aimed to assess whether clinical presentation per se predisposes to bleeding in patients undergoing PCI and if the Academic Research Consortium (ARC)-high bleeding risk (HBR) criteria perform consistently among acute (ACS) and chronic (CCS) coronary syndrome patients.

Methods: Consecutive patients undergoing PCI from the Bern PCI Registry were stratified by clinical presentation. Bleeding events at 1 year were compared in ACS versus CCS patients, and the originally-defined ARC-HBR criteria were assessed.

Results: Among 16,821 patients, 9,503 (56.5%) presented with ACS. At 1 year, BARC 3 or 5 bleeding occurred in 4.97% and 3.60% of patients with ACS and CCS, respectively. After adjustment, ACS remained associated with higher BARC 3 or 5 bleeding risk (adjusted HR: 1.21; 95% CI: 1.01-1.43; p=0.034), owing to non-access site-related occurrences, which mainly accrued within the first 30 days after PCI. The ARC-HBR score had lower discrimination among ACS compared with CCS patients, and its performance slightly improved when ACS was computed as a minor criterion.

Conclusions: ACS presentation per se predicts 1-year major bleeding risk after PCI. The ARC-HBR score discrimination appeared lower in ACS than CCS, and its overall performance improved numerically when ACS was computed as an additional minor risk criterion.

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