Comparison of Performance between ARC-HBR Criteria and PRECISE-DAPT Score in Patients Undergoing Percutaneous Coronary Intervention

Abstract

The proper management of bleeding risk in patients undergoing percutaneous coronary intervention (PCI) is critical. Recently, the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria have been proposed as a standardized tool for predicting bleeding risk. We sought to compare the predictive performance of ARC-HBR criteria and the PRECISE-DAPT score for bleeding in Korean patients undergoing PCI. We recruited 1418 consecutive patients undergoing PCI from January 2012 through December 2018 (Dong-A University Medical Center, Busan, Korea). The ARC-HBR and PRECISE-DAPT scores showed a high AUC for three bleeding definitions (AUC 0.75 and 0.77 for BARC 3 to 5; AUC 0.68 and 0.71 for TIMI minor to major; AUC 0.81 and 0.82 for GUSTO moderate to severe, respectively) and all-cause death (AUC 0.82 and 0.82, respectively). When compared with the ARC-HBR score, the discriminant ability of the PRECISE-DAPT score was not significantly different for bleeding events and all-cause death. The ARC-HBR criteria and PRECISE-DAPT scores demonstrated reasonably good discriminatory capacity with respect to 1-year bleeding events in Korean patients treated with DAPT, regardless of the bleeding definition. Our findings also suggest that the simple PRECISE-DAPT score is as useful as ARC-HBR criteria in predicting bleeding and all-cause death after PCI.

Prevalence of High Bleeding Risk among Hospitalized Suspected NSTEMI Patients

“…NSAIDs or steroids were moderately prevalent. Previous studies have reported similar results [ 14 , 19 , 20 , 21 , 22 , 23 , 24 ]. OAC-use and age seem to be even more prevalent in Finnish patients, but active malignancy is less frequently encountered.…”

“…The prevalence of HBR according to ARC–HBR criteria in studies of European and Asian populations has ranged from 30% to 50%, and the incidence of major bleeding events in the HBR groups of these studies has consistently been ≥4% at 1 year [ 14 , 19 , 20 , 21 , 22 , 23 , 24 ]. The highest major bleeding rates were reported in Korea.…”

“…The highest major bleeding rates were reported in Korea. HBR was detected in 35.4% of Korean patients, and the incidence of major bleeding among this group at 1 year was 31.3% (BARC 3 to 5), even though some HBR factors—such as OAC use—were selected as exclusion criteria [ 22 ]. In a study concerning over 16,000 patients from Bern PCI registry, 34.7% were at HBR, and the incidence of major bleeding at 1 year was 7.9% (BARC 3 or 5) [ 19 ].…”

“…In DAPT trials, HBR or some of its underlying constituents are often selected as exclusion criteria. Studies show that bleeding risk gets incrementally higher as risk factors, such as ARC–HBR, accumulate [ 19 , 20 , 21 , 22 , 23 , 24 ]. As a result, the prevalence of HBR and actual bleeding rates could be even higher than reported.…”

“…OAC-use and age seem to be even more prevalent in Finnish patients, but active malignancy is less frequently encountered. It is noteworthy that several of the minor ARC–HBR criteria in isolation predict a major bleeding incidence ≥ 4% at 1 year [ 19 , 20 , 21 , 22 ], particularly age, moderate CKD, and mild anemia, which are also the most prevalent ones.…”