Clinical Research
Acute Coronary Syndromes
The Prognostic Value of Bleeding Academic Research Consortium (BARC)-Defined Bleeding Complications in ST-Segment Elevation Myocardial Infarction: A Comparison With the TIMI (Thrombolysis In Myocardial Infarction), GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries), and ISTH (International Society on Thrombosis and Haemostasis) Bleeding Classifications

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Objectives

The aim of the present analysis was to compare 1-year mortality prediction of Bleeding Academic Research Consortium (BARC)-defined bleeding complications with existing bleeding definitions in patients with ST-segment elevation myocardial infarction (STEMI) and to investigate the prognostic value of the individual data elements of the bleeding classifications for 1-year mortality.

Background

BARC recently proposed a novel standardized bleeding definition.

Methods

The in-hospital occurrence of bleeding defined according to the BARC, TIMI (Thrombolysis In Myocardial Infarction), GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries), and ISTH (International Society on Thrombosis and Haemostasis) bleeding classifications was assessed in 2,002 STEMI patients undergoing primary percutaneous coronary intervention between January 1, 2003, and July 31, 2008.

Results

BARC types 2, 3, 4, and 5 bleeding occurred in 4.4%, 14.2%, 1.4%, and 0.3% of patients, respectively. By multivariable analysis, GUSTO- and ISTH-defined bleeding was not significantly associated with 1-year mortality, whereas TIMI major and BARC type 3b or 3c bleeding conferred a 2-fold higher risk of 1-year mortality (hazard ratios [HRs]: 2.00 [95% confidence interval (CI): 1.32 to 3.01] and 1.84 [95% CI: 1.23 to 2.77], respectively). Data elements most strongly associated with mortality were a hemoglobin decrease ≥5 g/dl (HR: 1.94 [95% CI: 1.26 to 2.98]), the use of vasoactive agents for bleeding (HR: 2.01 [95% CI: 0.91 to 4.44]), cardiac tamponade (HR: 2.38 [95% CI: 0.56 to 10.1]), and intracranial hemorrhage (HRs for 1-year mortality were not computable because there was only 1 patient with intracranial bleeding).

Conclusions

Both the BARC and TIMI bleeding classification identified STEMI patients at risk of 1-year mortality.

Key Words

major bleeding
primary percutaneous coronary intervention
ST-segment elevation myocardial infarction

Abbreviations and Acronyms

aPTT
activated partial thromboplastin time
BARC
Bleeding Academic Research Consortium
CABG
coronary artery bypass graft
GUSTO
Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries
IDI
integrated discrimination improvement
ISTH
International Society on Thrombosis and Haemostasis
NRI
net reclassification improvement
PCI
percutaneous coronary intervention
PPCI
primary percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction
TIMI
Thrombolysis In Myocardial Infarction

Cited by (0)

This work was supported by The Nuts OHRA Foundation (SNO-T-0702-61). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.