DOI: 10.1161/circ.148.suppl_1.14598 ISSN: 0009-7322

Abstract 14598: Predictive Value of the High Bleeding Risk Criteria of the Academic Research Consortium in Black and White Individuals

Rebecca Cohen, Alessandro Spirito, Samantha Sartori, Birgit Vogel, Brunna Pileggi, Paris Pentousis, Kenneth F Smith, Samin K Sharma, Annapoorna Kini, George Dangas, Roxana Mehran, Yujin Zhang
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: The High Bleeding Risk (HBR) criteria of the Academic Research Consortium (ARC) are a valuable tool for bleeding risk stratification in White and Asian patients undergoing percutaneous coronary intervention (PCI).

Hypothesis: The predictive value of the ARC-HBR criteria may vary in Black patients.

Methods: Patients who underwent PCI at a large tertiary-care center from 2012 to 2019 who self-reported as non-Hispanic White or Black were included and stratified in HBR and no-HBR based on the ARC-HBR definition. The primary outcome was major bleeding (according to a study specific definition) at 1 year after PCI; secondary outcomes included post-discharge major bleeding, all-cause death and myocardial infarction (MI).

Results: Among 9462 patients, 1881 (19.9%) identified as Black and 7581 (80.1%) as White. In these two groups, the HBR criteria were met by 50.8% and 45.6% of patients, respectively, and the frequency of each individual ARC-HBR criterion differed (Figure 1). HBR was associated with a consistent higher risk of major bleeding in Black (7.8% vs. 3.5%, adj. HR 2.02, 95% CI 1.29-3.17) and White patients (7.5% vs. 2.7%, adj. HR 2.49, 95% CI 1.95-3.18, interaction p-value 0.451) (Figure 1). The HBR-related risk of post-discharge bleeding tended to be higher in Black patients (adj. HR 1.67, 95% CI 0.84-3.33) and was significantly increased in White patients (adj HR 3.09, 95% 2.06-4.64, interaction p-value 0.341). All-cause death and MI were increased in HBR patients consistently in the Black and the White group. The predictive value of the ARC-HBR criteria for major bleeding and post-discharge bleeding was good in both Black (0.72 and 0.74, respectively) and White (0.70 and 0.68, respectively).

Conclusions: In Black and White patients undergoing PCI, the ARC-HBR criteria were differently distributed and had a good predictive value for major bleeding in both groups.

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