Validation of the Academic Research Consortium for High Bleeding Risk criteria in Chinese patients with atrial fibrillation and acute coronary syndrome or undergoing percutaneous coronary intervention.

Abstract

BACKGROUND:

This study aims to validate the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria in Chinese patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) who received both oral anticoagulants (OAC) and antiplatelet therapy (APT).

METHODS:

930 consecutive patients with AF and ACS or undergoing PCI receiving both OAC and APT were recruited and followed up for 1 year. The primary endpoint was BARC type 3 or 5 bleeding. The secondary endpoints included BARC type 2, 3, or 5 bleeding, TIMI major bleeding, TIMI major or minor bleeding, and major adverse cardiovascular events (a composite of all-cause death, stroke, non-central nervous system embolism, myocardial infarction, definite or probable stent thrombosis, and target vessel revascularization). Cox regressions were performed to evaluate the association between the ARC-HBR score and outcomes. Discrimination was evaluated through analysis of the receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

RESULTS:

Compared to patients with no HBR other than OAC, patients with HBR besides OAC tended to have more comorbidities and worse outcomes. The ARC-HBR score was significantly associated with the primary and secondary endpoints, both as a continuous variable and as a categorical variable. The ARC-HBR score performed better than the HAS-BLED score (c-statistic: 0.692 vs. 0.575, NRI = 0.313, IDI = 0.061) and the PRECISE-DAPT score (c-statistic: 0.692 vs. 0.616, NRI = 0.393, IDI = 0.049).

CONCLUSIONS:

In patients with AF and ACS or undergoing PCI receiving both OAC and APT, the ARC-HBR score was a significant predictor of 1-year bleeding and ischemic endpoints. The ARC-HBR score performed better than the HAS-BLED score and the PRECISE-DAPT score in BARC type 3 or 5 bleeding prediction.

• Authors: Si-Qi Lyu, Jun Zhu, Juan Wang, Shuang Wu, Han Zhang, Xing-Hui Shao, Yan-Min Yang
• Journal: Thrombosis research (Thromb Res) Vol. 209 Pg. 16-22 (Jan 2022) ISSN: 1879-2472 [Electronic] United States
• PMID: 34844044 (Publication Type: Journal Article)
• Copyright: Copyright © 2021. Published by Elsevier Ltd.

Chemical References

• Platelet Aggregation Inhibitors

Topics

• Acute Coronary Syndrome (surgery)
• Atrial Fibrillation
• China
• Hemorrhage (chemically induced)
• Humans
• Percutaneous Coronary Intervention (adverse effects)
• Platelet Aggregation Inhibitors
• Risk Factors
• Treatment Outcome