The prognostic value of Bleeding Academic Research Consortium (BARC) defined bleeding complications in ST-segment elevation myocardial infarction: A Comparison with the Thrombolysis In Myocardial Infarction (TIMI), Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries (GUSTO) and International Society of Thrombosis and Haemostasis (ISTH) bleeding classifications.
J Am Coll Cardiol. 2014 Mar 10;
Authors: Kikkert WJ, van Geloven N, van der Laan MH, Vis MM, Baan J, Koch KT, Peters RJ, de Winter RJ, Piek JJ, Tijssen JG, Henriques JP
OBJECTIVES: The aim of the current analysis was compare one year mortality prediction of BARC defined bleeding complications with existing bleeding definitions in ST-segment elevation myocardial infarction (STEMI) patients and to investigate the prognostic value of the individual data elements of the bleeding classifications for one year mortality.
BACKGROUND: The Bleeding Academic Research Consortium (BARC) recently proposed a novel standardized bleeding definition.
METHODS: The in-hospital occurrence of BARC, Thrombolysis in Myocardial In Myocardial Infarction (TIMI), Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries (GUSTO), and International Society of Thrombosis and Haemostasis (ISTH) defined bleeding was assessed in 2002 STEMI patients undergoing primary percutaneous coronary intervention (PPCI) between 1-1-2003 and 31-07-2008.
RESULTS: BARC type 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 bleeding were not significantly associated with one year mortality, whereas TIMI major and BARC type 3b or 3c conferred a twofold higher risk of one year mortality (HR 2.00; 95% confidence interval (CI ) 1.32 - 3.01 and HR 1.84; 95% CI 1.23 - 2.77 respectively). Data elements most strongly associated with mortality were a hemoglobin drop ≥ 5 g/dL (HR 1.94; 95% CI 1.26 - 2.98), the use of vasoactive agents for bleeding (HR 2.01; 95% CI 0.91 - 4.44), cardiac tamponade (HR 2.38; 95% CI 0.56 - 10.1), and intracranial hemorrhage.
CONCLUSION: Both the BARC and TIMI bleeding classification identify STEMI patients at risk of one year mortality.
PMID: 24657697 [PubMed - as supplied by publisher]