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

Abstract

Aims:The Academic Research Consortium (ARC) has proposed international criteria to standardize the definition of high bleeding risk (HBR) in patients undergoing percutaneous coronary intervention (PCI). In this context, Japan has also established its own guidelines, that is, the Japanese version of HBR (J-HBR) criteria. However, the J-HBR criteria have not been fully validated, especially in patients with acute myocardial infarction (MI).Methods: This bi-center registry included 1079 patients with acute MI undergoing primary PCI in a contemporary setting. Patient bleeding risks were evaluated using the ARC-HBR and J-HBR criteria. The primary endpoint was rates of major bleeding events (Bleeding Academic Research Consortium type 3 or 5) at 1 year.Results: Of the 1079 patients, 505 (46.8%) and 563 (52.2%) met the ARC-HBR and J-HBR criteria, respectively. Patients who met the J-HBR criteria were found to have a higher rate of major bleeding events at 1 year than those who did not (12.8% vs. 3.3%, p＜0.001). When patients were scored and stratified using the J-HBR major and minor criteria, risks of major bleedings were progressively increased with the increase in the number of J-HBR criteria. In the receiver operating characteristic curve analysis, the ARC-HBR and J-HBR significantly predicted subsequent major bleedings after PCI, with ARC-HBR having greater predictive ability than J-HBR.Conclusions: More than half of the patients with acute MI undergoing primary PCI in Japan met the J-HBR criteria. Although the J-HBR criteria successfully identified patients who were likely to develop major bleeding events after primary PCI, the superiority of J-HBR to ARC-HBR in predicting bleeding outcomes warrants further investigation.

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 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). 19 , 25 – 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.…”

“…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 – 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).…”

“…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). 28 In the CREDO-Kyoto registry cohort 3, 29 the cumulative incidence of major bleeding events in the HBR group according to the J-HBR criteria within 1 year was higher than in our study (14.0% vs. 8.8% within 1 year, respectively), regardless of whether the proportion of patients with HBR was similar (64% vs. 66.3%, respectively). This was partly attributable to the increased use of the transfemoral approach in the CREDO-Kyoto registry cohort 3 than in our study (53% vs. 28%, respectively) and advances in PCI devices that have allowed for shorter DAPT duration.…”

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

“…We conducted a retrospective, bicenter registry study at 2 tertiary referral hospitals, Chiba University Hospital and Eastern Chiba Medical Center [ 13 , 14 , 15 , 16 , 17 , 18 ]. From January 2012 to March 2020, a total of 1102 patients with acute MI including ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI) underwent primary PCI.…”

Prognostic Value of Natriuretic Peptide Levels and In-Hospital Heart Failure Events in Patients With Acute Myocardial Infarction

“…This was a retrospective, observational, bicenter study. [16][17][18][19][20][21] Between January 2012 and March 2020, 1,102 AMI patients I schemic heart disease, such as acute myocardial infarction (AMI), is a major underlying pathogenic factor in heart failure (HF), accounting for approximately 50% of cases in the current era, 1,2 and HF event is a strong predictor of worse outcomes among patients with AMI. 3,4 B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) are natriuretic peptides (NPs) secreted by the cardiac ventricles in response to end-diastolic pressure and volume, 5 and are widely used as diagnostic biomarkers for HF in clinical practice.…”