Correlation Between the Japanese Version of the High Bleeding Risk (J-HBR) Criteria and the PRECISE-DAPT Score, and Optimal J-HBR Cut-Off Score to Predict Major Bleeding

Abstract

Background:The correlation between the Japanese version of high bleeding risk (J-HBR) criteria and the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score is unknown, as is the relationship of both risk scores with ischemic events. Methods and Results:This study enrolled 842 patients who underwent percutaneous coronary intervention (PCI) between January 2016 and December 2020. The 2 bleeding risk scores at the time of PCI and the subsequent risk of bleeding and ischemic events over a 1-year follow-up were examined. The J-HBR score was significantly correlated with the PRECISE-DAPT score (r=0.731, P<0.001). However, 1 year after PCI, the J-HBR was not significantly associated with the incidence of major bleeding and ischemic events (log-rank, P=0.058 and P=0.351, respectively), whereas the PRECISE-DAPT score predicted both the incidence of major bleeding and ischemic events (log-rank, P=0.006 and P=0.019, respectively). According to receiver operating characteristic curve analysis, a J-HBR score ≥1.5 was significantly associated with a higher cumulative incidence of major bleeding, but not ischemic events (log-rank, P=0.004 and P=0.513, respectively). Conclusions:The J-HBR score is highly correlated with the PRECISE-DAPT score. A J-HBR score ≥1.5 can identify high bleeding risk patients without an increased risk of ischemic events.

Comparison of Discriminative Ability of Bleeding Risk Criteria and Scores for Predicting Short- and Mid-Term Major Bleeding Events in Patients Undergoing Percutaneous Coronary Intervention

“…The J-HBR score comprises more risk factors than the other risk scores and identified a greater proportion of patients with HBR. In line with previous studies, 19 , 26 , 27 , 28 the J-HBR score was more sensitive than other bleeding risk scores in the present study and may be a highly effective screening tool for patients with HBR. Thus, patients identified as non-HBR according to the J-HBR score could be considered to have a low risk of bleeding.…”

“… 6 Although the use of risk scores to predict bleeding events is important, it has not been clarified whether the ARC-HBR and J-HBR criteria have better discriminative ability for major bleeding events than other risk scores. The discriminative abilities of the J-HBR, ARC-HBR, and PRECISE-DAPT scores for predicting major bleeding events within 1 year or more are comparable, 19 , 25 , 26 and the results of our study also showed no significant differences in the discriminative ability for predicting major bleeding events among the J-HBR, ARC-HBR, and PRECISE-DAPT scores in the time-dependent ROC curve analysis. In contrast to previous studies, 19 , 25 – 28 the AUC values in the present study for the J-HBR, ARC-HBR, and PRECISE-DAPT scores were higher (0.77–0.86 vs. 0.61–0.75 in previous studies).…”

“…In contrast to previous studies, 19,25-28 the AUC values in the present study for the J-HBR, ARC-HBR, and PRECISE-DAPT scores were higher (0.77-0.86 vs. 0.61-0.75 in previous studies). 19,[25][26][27][28] We observed few major bleeding events in the non-HBR group according to the J-HBR and ARC-HBR scores, which may have contributed to the higher discriminative ability of those scores. The reason for fewer major bleeding events in our study could be the limited use of the transfemoral approach (28% vs. 58-76% in previous studies) 19,25-27 and the smaller incidence of acute coronary syndrome (52.2% vs. 100% in a previous study).…”

“…Bleeding risk (e.g., CKD, PVD, atrial fibrillation, and heart failure) generally overlaps with ischemic risk, 14 and patients with HBR according to the J-HBR, ARC-HBR, and PRECISE-DAPT scores show increased occurrence of bleeding and ischemic events. 18 , 19 , 26 , 29 In the present study, patients with HBR according to the ARC-HBR and PRECISE-DAPT scores had a higher cumulative incidence of ischemic events than patients with non-HBR; however, patients with HBR according to the J-HBR score had an incidence of ischemic events similar to those of patients with non-HBR, which suggests that the J-HBR score may be able to identify patients with HBR without increased ischemic risk. The possible explanations for this phenomenon are as follows.…”

Impact of the Japanese Version of High Bleeding Risk Criteria on Clinical Outcomes in Patients with ST-segment Elevation Myocardial Infarction

“…The Kolmogorov-Smirnov test was performed to determine whether the continuous variables were Because the bleeding and the thrombotic risks are different between the Japanese population and the Western population 11,12) , the Japanese Circulation Society issued the Japanese version of the HBR (J-HBR) criteria in 2020 13) . There are several validation studies regarding J-HBR [14][15][16][17][18] . However, J-HBR has not been sufficiently studied in patients with STEMI who undergo primary PCI, in whom HBR is the most problematic.…”