Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
Rev Esp Cardiol (Engl Ed). 2022 May;75(5):375-383. doi: 10.1016/j.rec.2021.03.006. Epub 2021 Apr 14.
The recent Academic Research Consortium for High Bleeding Risk (ARC-HBR) proposal did not consider acute coronary syndrome (ACS), by consensus, a bleeding criterion per se despite being a high bleeding risk (HBR) scenario. We investigated the applicability of the ARC-HBR classification and criteria in ACS patients.
Patients with ACS undergoing coronary stenting between 2012 and 2018 at a tertiary hospital were retrospectively classified as being at HBR if they met ≥ 1 major or ≥ 2 minor ARC-HBR criteria. The primary endpoint was the 1-year cumulative incidence of Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding.
Among 4412 patients, 29.5% were at HBR. The incidence of bleeding was higher in the HBR group than in the non-HBR group (9.4% vs 1.3%; P < .01). The rates of in-hospital periprocedural and postdischarge bleeding were also higher in the HBR group (4.3% vs 0.5% and 5.3% vs 0.9%, respectively; P < .01). Bleeding risk gradually increased with increasing ARC-HBR criteria: 1.8%, 5.0%, 9.4%, 16.8%, 25.2%, and 25.9% for 1 isolated minor criterion, ≥ 2 isolated minor criteria, 1 major criterion (isolated or plus 1 minor criterion), 1 major plus ≥ 2 minor criteria, ≥ 2 major criteria (isolated or plus 1 minor criterion), and ≥ 2 major plus ≥ 2 minor criteria, respectively. Sixteen (80%) out of 20 ARC-HBR criteria satisfied the ARC-HBR predefined cutoffs for BARC 3 or 5 bleeding risk.
This study supports the use of the ARC-HBR classification and criteria in the ACS setting. The ARC-HBR classification provides an accurate major bleeding risk estimate and it seems suitable for the identification and management of patients at HBR.
最近的学术研究促进高出血风险联盟（ARC-HBR）建议，尽管急性冠脉综合征（ACS）是一种高出血风险（HBR）的情况，但并未通过共识将其本身视为出血标准。我们研究了 ARC-HBR 分类和标准在 ACS 患者中的适用性。
回顾性分析 2012 年至 2018 年在一家三级医院接受经皮冠状动脉介入治疗的 ACS 患者，如果符合≥1 项主要标准或≥2 项次要标准，则被归类为 HBR。主要终点是 1 年累积的 Bleeding Academic Research Consortium（BARC）3 或 5 型出血发生率。
在 4412 例患者中，有 29.5%为 HBR。HBR 组的出血发生率高于非 HBR 组（9.4%比 1.3%；P<0.01）。HBR 组的住院期间、围手术期和出院后出血发生率也较高（4.3%比 0.5%和 5.3%比 0.9%；P<0.01）。随着 ARC-HBR 标准的增加，出血风险逐渐增加：1 项孤立的次要标准、≥2 项孤立的次要标准、1 项主要标准（孤立或加 1 项次要标准）、1 项主要加≥2 项次要标准、≥2 项主要标准（孤立或加 1 项次要标准）和≥2 项主要加≥2 项次要标准的发生率分别为 1.8%、5.0%、9.4%、16.8%、25.2%和 25.9%。20 项 ARC-HBR 标准中有 16 项（80%）符合 ARC-HBR 预设的 BARC 3 或 5 型出血风险的截止值。
本研究支持在 ACS 环境中使用 ARC-HBR 分类和标准。ARC-HBR 分类可准确评估主要出血风险，似乎适合识别和管理 HBR 患者。
