Yohei Sotomi1, Shungo Hikoso1, Daisaku Nakatani1, Tomoharu Dohi1, Hiroya Mizuno1, Katsuki Okada1,2,3, Hirota Kida1, Bolrathanak Oeun1, Akihiro Sunaga1, Taiki Sato1, Tetsuhisa Kitamura4, Yasuhiko Sakata5, Hiroshi Sato6, Masatsugu Hori7, Issei Komuro8, Yasushi Sakata1. 1. Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine. 2. Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine. 3. Division of Fostering Required Medical Human Resources, Center for Infectious Disease Education and Research (CiDER), Osaka University. 4. Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University. 5. Department of Clinical Medicine and Development and Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center. 6. School of Human Welfare Studies Health Care Center and Clinic, Kwansei Gakuin University. 7. Osaka International Cancer Institute. 8. Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine.
Abstract
AIMS: We aimed to establish a practical method for the assessment of tradeoff between thrombotic and bleeding risks. METHODS: We aimed to investigate the balance between bleeding risk and coronary thrombotic risk according to the number of the Academic Research Consortium for high bleeding risk (ARC-HBR) criteria in the multicenter prospective ST/non-ST elevation myocardial infarction (STEMI/NSTEMI) registry (N=12,093). Patients were divided as follows by the number of ARC-HBR criteria fulfilled: group 0, 0 major with ≤ 1 minor (N=6,792); group 1, 1 major with 0 minor (N=1,705); group 2, 0 major with ≥ 2 minors (N=790); group 3, 1 major with ≥ 1 minor (N=1,709); group 4, 2 majors with ≥ 0 minors (N=861); and group 5, ≥ 3 majors with ≥ 0 minor (N=236). We assessed the acute-phase absolute risk differences between bleeding and coronary thrombotic events in each group. RESULTS: At 7-day follow-up, all patients (groups 0-5) had a higher risk of major bleeding than that of any myocardial infarction (MI). Patients at ARC-HBR (groups 1-5) had a balanced risk between fatal MI and fatal bleeding, whereas patients at non-ARC-HBR (group 0) had a higher risk of fatal MI than that of fatal bleeding. CONCLUSIONS: All STEMI/NSTEMI patients have a relatively high risk of major bleeding as compared with the risk of any MI in the acute phase. The ARC-HBR criteria would be a practical tool for assessing the tradeoff between fatal bleeding and fatal MI risks. This practical assessment would be helpful for the optimal decision-making of appropriate treatment strategy considering the balance between bleeding and coronary thrombotic risks.
AIMS: We aimed to establish a practical method for the assessment of tradeoff between thrombotic and bleeding risks. METHODS: We aimed to investigate the balance between bleeding risk and coronary thrombotic risk according to the number of the Academic Research Consortium for high bleeding risk (ARC-HBR) criteria in the multicenter prospective ST/non-ST elevation myocardial infarction (STEMI/NSTEMI) registry (N=12,093). Patients were divided as follows by the number of ARC-HBR criteria fulfilled: group 0, 0 major with ≤ 1 minor (N=6,792); group 1, 1 major with 0 minor (N=1,705); group 2, 0 major with ≥ 2 minors (N=790); group 3, 1 major with ≥ 1 minor (N=1,709); group 4, 2 majors with ≥ 0 minors (N=861); and group 5, ≥ 3 majors with ≥ 0 minor (N=236). We assessed the acute-phase absolute risk differences between bleeding and coronary thrombotic events in each group. RESULTS: At 7-day follow-up, all patients (groups 0-5) had a higher risk of major bleeding than that of any myocardial infarction (MI). Patients at ARC-HBR (groups 1-5) had a balanced risk between fatal MI and fatal bleeding, whereas patients at non-ARC-HBR (group 0) had a higher risk of fatal MI than that of fatal bleeding. CONCLUSIONS: All STEMI/NSTEMI patients have a relatively high risk of major bleeding as compared with the risk of any MI in the acute phase. The ARC-HBR criteria would be a practical tool for assessing the tradeoff between fatal bleeding and fatal MI risks. This practical assessment would be helpful for the optimal decision-making of appropriate treatment strategy considering the balance between bleeding and coronary thrombotic risks.
Entities:
Keywords:
Academic Research Consortium; High bleeding risk; Myocardial infarction; Thrombotic risk; Tradeoff
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