Masahiro Natsuaki1, Takeshi Morimoto2, Hiroki Shiomi3, Kyohei Yamaji4, Hirotoshi Watanabe3, Satoshi Shizuta3, Takao Kato3, Kenji Ando4, Yoshihisa Nakagawa5, Yutaka Furukawa6, Tomohisa Tada7, Kazuya Nagao8, Kazushige Kadota9, Mamoru Toyofuku10, Takeshi Kimura3. 1. Department of Cardiovascular Medicine, Saga University, Japan (M.N.). 2. Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.). 3. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (H.S., H.W., S.S., T. Kato, T. Kimura). 4. Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (K.Y., K.A.). 5. Department of Cardiovascular Medicine, Shiga University of Medical Science Hospital, Otsu, Japan (Y.N.). 6. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.). 7. Division of Cardiology, Shizuoka General Hospital, Japan (T.T.). 8. Department of Cardiovascular Center, Osaka Red Cross Hospital, Japan (K.N.). 9. Division of Cardiology, Kurashiki Central Hospital, Japan (K.K.). 10. Division of Cardiology, Wakayama Red Cross Hospital, Wakayama, Japan (M.T.).
Abstract
BACKGROUND: Recently, the Academic Research Consortium for High Bleeding Risk (ARC-HBR) has been proposed to standardize the definition of HBR, which was arbitrarily defined as a Bleeding Academic Research Consortium 3 or 5 bleeding ≥4% at 1-year. However, the prevalence and the expected bleeding event rate of HBR patients defined by ARC-HBR criteria are currently unknown in the real-world percutaneous coronary intervention practice. METHODS: We applied the ARC-HBR criteria in the CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) registry cohort-2, a multicenter registry that enrolled 13 058 consecutive patients who underwent their first percutaneous coronary intervention. The primary bleeding end point was defined as the Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries moderate/severe bleeding. There were 5570 patients (43%) in the HBR group and 7488 patients in the no-HBR group. RESULTS: Cumulative incidence of the primary bleeding end point was much higher in the HBR group than in the no-HBR group (10.4% versus 3.4% at 1-year, and 18.9% versus 6.6% at 5-year, P<0.0001). Presence of each ARC-HBR major or even minor criterion, in isolation, with the exception of liver cirrhosis and prior ischemic stroke, was also associated with major bleeding risk higher than 4% at 1-year. Cumulative 5-year incidence of the primary bleeding end point got incrementally higher as the number of the ARC-HBR major criteria increased (≥3 majors: 49.9%, 2 majors: 30.6%, 1 major: 18.5%, ≥2 minors: 14.7%, and no-HBR: 6.6%, P<0.0001). CONCLUSIONS: ARC-HBR criteria successfully identified those patients with very HBR after percutaneous coronary intervention, who represented 43% of patients in this all-comers registry.
BACKGROUND: Recently, the Academic Research Consortium for High Bleeding Risk (ARC-HBR) has been proposed to standardize the definition of HBR, which was arbitrarily defined as a Bleeding Academic Research Consortium 3 or 5 bleeding ≥4% at 1-year. However, the prevalence and the expected bleeding event rate of HBRpatients defined by ARC-HBR criteria are currently unknown in the real-world percutaneous coronary intervention practice. METHODS: We applied the ARC-HBR criteria in the CREDO-Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) registry cohort-2, a multicenter registry that enrolled 13 058 consecutive patients who underwent their first percutaneous coronary intervention. The primary bleeding end point was defined as the Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries moderate/severe bleeding. There were 5570 patients (43%) in the HBR group and 7488 patients in the no-HBR group. RESULTS: Cumulative incidence of the primary bleeding end point was much higher in the HBR group than in the no-HBR group (10.4% versus 3.4% at 1-year, and 18.9% versus 6.6% at 5-year, P<0.0001). Presence of each ARC-HBR major or even minor criterion, in isolation, with the exception of liver cirrhosis and prior ischemic stroke, was also associated with major bleeding risk higher than 4% at 1-year. Cumulative 5-year incidence of the primary bleeding end point got incrementally higher as the number of the ARC-HBR major criteria increased (≥3 majors: 49.9%, 2 majors: 30.6%, 1 major: 18.5%, ≥2 minors: 14.7%, and no-HBR: 6.6%, P<0.0001). CONCLUSIONS: ARC-HBR criteria successfully identified those patients with very HBR after percutaneous coronary intervention, who represented 43% of patients in this all-comers registry.
Authors: Davide Capodanno; Deepak L Bhatt; C Michael Gibson; Stefan James; Takeshi Kimura; Roxana Mehran; Sunil V Rao; Philippe Gabriel Steg; Philip Urban; Marco Valgimigli; Stephan Windecker; Dominick J Angiolillo Journal: Nat Rev Cardiol Date: 2021-08-23 Impact factor: 32.419
Authors: Daphné Doomun; Ianis Doomun; Sara Schukraft; Diego Arroyo; Selma Cook; Tibor Huwyler; Peter Wenaweser; Jean-Christophe Stauffer; Jean-Jacques Goy; Mario Togni; Serban Puricel; Stéphane Cook Journal: Front Cardiovasc Med Date: 2021-12-02