The ARC-HBR criteria was more sensitive to identify patients with future bleedings than other contemporary risk scores at the cost of specificity. The bleeding risk was related to its individual components.
Patients at HBR defined by the ARC-HBR criteria had a higher risk of BARC 3 or 5 bleeding as well as DOCE. The ARC-HBR criteria had higher sensitivity than PRECISE-DAPT score and PARIS bleeding risk score (63.8%, 53.1%, 31.9%), but lower specificity (62.7%, 71.3%, 86.5%) for BARC 3 or 5 bleeding. The degree of risk and prognostic value was related to the risk factors composing the criteria. 6.1% P<0.001) compared with those without HBR. Among 12,121 patients, those at HBR (n=4,781, 39.4%) had an increased risk of BARC 3 or 5 bleeding (6.4% vs. The primary endpoint was Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding at 1 year ischemic outcomes were assessed using the device-oriented composite endpoints (DOCE) of cardiac death, target-vessel myocardial infarction, and target lesion revascularization. Patients were considered to be at HBR if at least 1 major criterion or 2 minor criteria were met. We aimed to validate the ARC-HBR criteria for the bleeding outcomes using a large cohort of patients undergoing PCI.īetween 20, patients undergoing PCI were prospectively included in the Bern PCI Registry. The Academic Research Consortium for high bleeding risk (ARC-HBR) defined consensus-based criteria for patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI). In ACS patients treated with DESs, ticagrelor monotherapy after 3-month DAPT was associated with lower rate of adverse clinical outcomes regardless of HBR, with similar magnitudes of therapy effect between HBR and non-HBR.Ĭ Identifier: NCT02494895. Results were consistent by PRECISE-DAPT score (p-interaction=0.178). Ticagrelor monotherapy after 3-month DAPT was associated with lower primary outcome rate than ticagrelor-based 12-month DAPT regardless of HBR by ARC-HBR criteria, with similar magnitudes of therapy effect for HBR and non-HBR patients (p-interaction=0.400). The primary outcome rate was higher in HBR versus non-HBR patients (by ARC-HBR criteria: hazard ratio, 2.87 95% confidence interval, 1.76-4.69 p<0.001 by PRECISE-DAPT score: HR, 3.09 95% CI, 1.92-4.98 p<0.001). Of the 2,980 patients without adverse events during the first 3 months after DES implantation, 453 (15.2%) were HBR by ARC-HBR criteria and 504 (16.9%) were HBR by PRECISE-DAPT score. The primary outcome was a 3-12 months net adverse clinical event (composite of major bleeding and adverse cardiac and cerebrovascular events). In this post-hoc analysis of the TICO trial, HBR was defined by 2 approaches: meeting Academic Research Consortium for HBR (ARC-HBR) criteria or Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent DAPT (PRECISE-DAPT) score ≥25. This study evaluated the impact of ticagrelor monotherapy after 3-month dual antiplatelet therapy (DAPT) according to HBR in acute coronary syndrome (ACS) patients treated with drug eluting stents (DESs). Identifying patients with high bleeding risk (HBR) is important when making decisions for antiplatelet therapy strategy.
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