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  • Validation of the Academic ...
    Cao, Davide; Mehran, Roxana; Dangas, George; Baber, Usman; Sartori, Samantha; Chandiramani, Rishi; Stefanini, Giulio G; Angiolillo, Dominick J; Capodanno, Davide; Urban, Philip; Morice, Marie-Claude; Krucoff, Mitchell; Goel, Ridhima; Roumeliotis, Anastasios; Sweeny, Joseph; Sharma, Samin K; Kini, Annapoorna

    Journal of the American College of Cardiology, 06/2020, Letnik: 75, Številka: 21
    Journal Article

    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). This study sought to validate the ARC definition for HBR patients in a contemporary real-world cohort. 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. 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. 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.