Relationship between in-hospital event rates and high bleeding risk score in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction

Abstract

Academic Research Consortium for High Bleeding Risk (ARC-HBR) was defined as a criterion for predicting the risk of bleeding in patients who undergo percutaneous coronary intervention (PCI). Major bleeding is related to in-hospital mortality. However, few studies examining the HBR criteria in patients with acute myocardial infarction (AMI) have been reported. We analyzed the relationship between HBR criteria in AMI patients and in-hospital events. This study was a single-center retrospective study that included 781 patients who underwent PCI for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) from January 2010 to December 2018. Patients were classified into the HBR group (n = 309, 39.6%) and non-HBR group (n = 472, 60.4%) and investigated. The primary endpoint was the incidence of in-hospital mortality, major bleeding, recurrent MI, and stroke. As a secondary endpoint, a multivariate analysis of cases of in-hospital death was performed to identify predictors of in-hospital mortality. As the primary outcome, the rate of all events in the HBR group was significantly higher than that in the non-HBR group (29.1% vs. 11.2%, p < 0.001). Among the individual events, the rates of major bleeding (11.3% vs. 3.8%, p < 0.001) and in-hospital mortality (16.2% vs. 4.2%, p < 0.001) were significantly higher in the HBR group. Regarding the secondary outcome, the overall in-hospital mortality rate was 9.0%. The multivariate analysis revealed that ejection fraction < 40%, HBR, Killip 4, and left main trunk lesion were significant predictors of in-hospital mortality. In conclusion, the HBR criteria were associated with in-hospital events in AMI patients who underwent primary PCI.

Prognostic Factors of In-Hospital Mortality in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock

“…Given that the relative prevalence of NSTEMI versus STEMI has been increasing globally, the prognostic impact of NSTEMI presentation may be even more important in the current era. Indeed, it is conceivable that the present study population represents a contemporary PCI population, with the use of intravascular ultrasound, drug-eluting stents, and MCS in 98.0%, 87.2%, and 56.6%, respectively, which is in line with current clinical practice patterns in Japan [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

Validation of the Domestic High Bleeding Risk Criteria for Japanese Patients with Acute Myocardial Infarction

“…In this context, the recent guidelines by the Japanese Circulation Society proposed the Japanese version of the HBR (J-HBR) criteria, in which Japanese-specific factors associated with HBR such as low body weight, frailty, heart failure, and peripheral artery disease were added to the original ARC-HBR criteria 6) . The ARC-HBR has been well validated in several previous studies [7][8][9][10] , but the applicability of J-HBR has been tested in only one large-scale all-comers PCI registry in Japan 11) . In addition, a recent report indicated that the performance of ARC-HBR to discriminate bleeding risks was lower in patients with acute coronary syndrome than those with chronic coronary syndrome 12) .…”