Predictive Value of the Academic Research Consortium High Bleeding Risk Criteria in Self-Identified Black Individuals Undergoing Percutaneous Coronary Intervention.

Abstract

Background: Whether the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria are a valuable tool for risk stratification in self-identified Black patients undergoing percutaneous coronary intervention (PCI) remains uncertain.

Aims: This study aims to assess the predictive ability of the ARC-HBR criteria in patients who identify as Black and White.

Methods: Consecutive patients undergoing PCI at a large tertiary-care center from 2012 to 2019, and self-reporting as Black or White, were included in the current retrospective observational analysis and stratified into HBR and non-HBR based on the ARC-HBR definition. The primary outcome was all-bleeding, defined as a composite of peri-procedural in-hospital and post-discharge bleeding at 1-year follow-up. Secondary outcomes included post-discharge bleeding, major adverse cardiovascular events (MACE)-a composite of all-cause death, myocardial infarction, or stroke- and its individual components. The discriminative ability of the ARC-HBR criteria to predict outcomes was computed using Harrell's C-index.

Results: Among 9462 patients included, 1881 (19.9%) identified as Black and 7581 (80.1%) as White. In these two groups, 50.8% of Black and 45.6% of White patients were classified as HBR, and a different distribution of the individual major and minor criteria was observed. Within the Black cohort, HBR was associated with a significantly higher risk of the primary bleeding endpoint, MACE, and all-cause mortality, with only a trend toward a higher rate of post-discharge bleeding and MI. Conversely, among White patients, HBR was associated with a significantly higher risk of the primary bleeding endpoint, as well as all secondary endpoints. These findings were confirmed after multivariable adjustment, with no significant interaction between race and HBR status with regard to outcomes.

Conclusions: In this contemporary PCI registry, the ARC-HBR criteria showed a good ability in identifying patients at increased risk of bleeding and thrombotic events, irrespective of self-reported Black or White race.