Risk stratification using the academic research consortium high bleeding risk criteria in patients with atrial fibrillation undergoing percutaneous coronary intervention

Abstract Background Previous studies have reported that the academic research consortium high bleeding risk (ARC-HBR) criteria are useful to predict the risk of bleeding events in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). However, there are few studies investigating the predictive value of the ARC-HBR criteria in patients with atrial fibrillation (AF) undergoing PCI. Purpose The purpose of this study was to investigate whether the ARC-HBR criteria can be applied to long-term risk stratification in patients with AF undergoing PCI. Methods Patients with AF undergoing PCI at 15 institutions between January 2015 and March 2021 were enrolled. The ARC-HBR score was calculated by assigning 1 point for each major criterion and 0.5 points for each minor criterion. Clinical outcomes within 1 year, including major adverse cardiovascular events (MACE: all-cause death, myocardial infarction, stent thrombosis, and stroke) and major bleeding events (BARC 3 or 5), were evaluated. Results A total of 723 patients were included in this analysis. The best cut-off values of J-HBR score determined by ROC curve analysis to predict MACE and major bleeding events were both 3.0. Of 723 patients, 161 (22.3%) had ARC-HBR score ≥3.0. In Kaplan-Meier curve analyses, the incidence of MACE as well as major bleeding events was significantly higher (log-rank p<0.001 and p=0.010) in patients with ARC-HBR score ≥3.0 compared to those with ARC-HBR score <3 (Figure 1). Conclusion The ARC-HBR score may be useful in assessing the risk of MACE, including thrombotic events, as well as bleeding events in AF patients undergoing PCI.Figure 1