Clinical and Coronary Artery Lesion Characteristics and Outcomes in Acute Coronary Syndrome Patients with High Bleeding Risk.

Background: Although it is well-known that patients with high bleeding risk (HBR) who undergo percutaneous coronary intervention (PCI) have poor clinical outcomes, the details have not been fully clarified for acute coronary syndrome (ACS) population. The aim of this study was to describe patient and lesion characteristics in patients with ACS and HBR as defined by the Academic Research Consortium (ARC).

Methods: Patients with ACS (n=961) who underwent optical coherence tomography (OCT)-guided PCI were investigated. They were divided into HBR and non-HBR groups according to the ARC HBR criteria. Clinical background, lesion characteristics on angiography and OCT, and clinical outcomes during the two-year follow-up period were compared between the groups.

Results: The HBR group comprised 307 patients (32%). The frequency of multi-vessel coronary disease was higher in the HBR group than the non-HBR group (34% vs. 26%, p=0.015). OCT findings demonstrated a higher frequency of calcified nodules as the underlying pathology for ACS in the HBR group (12% vs. 3%, p<0.001), with a correspondingly higher frequency of calcified plaques (55% vs. 39%, p<0.001). Kaplan-Meier estimates of the incidence of major bleeding (11.0% vs. 2.4%, p<0.001) and cardiac death (8.5% vs. 2.4%, p<0.001) were more prevalent for the HBR group than the non-HBR group during the follow-up period.

Conclusion: ACS patients with HBR factors had more advanced atherosclerosis which contributed to a higher prevalence of cardiac death as well as major bleeding complications.