Abstract
Limited data exist on the temporal trend of major bleeding and its prediction by the Academic Research Consortium-High Bleeding Risk (ARC-HBR) criteria in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). We investigated 10-year trends of major bleeding and predictive ability of the ARC-HBR criteria in AMI patients. In a multicenter registry of 10,291 AMI patients undergoing PCI between 2004 and 2014 the incidence of Bleeding Academic Research Consortium (BARC) 3 and 5 bleeding was assessed, and, outcomes in ARC-defined HBR patients with AMI were compared with those in non-HBR. The primary outcome was BARC 3 and 5 bleeding at 1 year. Secondary outcomes included all-cause mortality and composite of cardiovascular death, myocardial infarction, or ischemic stroke. The annual incidence of BARC 3 and 5 bleeding in the AMI population has increased over the years (1.8% to 5.8%; p < 0.001). At 1 year, ARC-defined HBR (n = 3371, 32.8%) had significantly higher incidence of BARC 3 and 5 bleeding (9.8% vs. 2.9%; p < 0.001), all-cause mortality (22.8% vs. 4.3%; p < 0.001) and composite of ischemic events (22.6% vs. 5.8%; p < 0.001) compared to non-HBR. During the past decade, the incidence of major bleeding in the AMI population has increased. The ARC-HBR criteria provided reliable predictions for major bleeding, mortality, and ischemic events in AMI patients.
Highlights
Bleeding in patients with acute myocardial infarction (AMI) is not uncommon and is a major concern as much as ischemic events after percutaneous coronary intervention (PCI) [1,2,3,4]
Of the 10,719 AMI patients who underwent PCI from January 2004 to August 2014, 10,291 (96.0%) patients completed 1-year follow-up and were analyzed in this study. 428 patients were lost to follow-up within 1 year after index procedure
The predictive ability of the criteria was verified in patients with non-ST segment elevation myocardial infarction (NSTEMI) and segment elevation myocardial infarction (STEMI), as well as in those treated with potent P2Y12 inhibitor
Summary
Bleeding in patients with acute myocardial infarction (AMI) is not uncommon and is a major concern as much as ischemic events after percutaneous coronary intervention (PCI) [1,2,3,4]. More potent P2Y12 inhibitor is implemented, the epidemiology of major bleeding in the AMI population is expected to be far different from the past. The risk of bleeding in AMI patients is higher than in those with chronic coronary syndrome or unstable angina [5,6,7]. Predicting bleeding risk and implementing appropriate antithrombotic strategy in AMI patients are more important than in those with other coronary artery diseases. No bleeding risk stratification system has been established to guide antithrombotic therapy in AMI
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
