Work

In-hospital prognosis of high bleeding risk patients with an acute coronary syndrome and successful percutaneous coronary intervention: a single-center real-world registry

Year: 2025

Type: article

Abstract: Introduction: The management of high bleeding risk (HBR) patients with an acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI) is challenging because these patients combine a severe thrombotic burden with a significant risk of bleeding complications.Aim: The aim of this study was to quantify the prevalence of HBR patients in a real-world ACS population, identify their in-hospital prognosis, and record their bleeding complications compared to non-HBR patients.Material and methods: In this real-world registry, patients with an ACS who had undergone successful revascularization with PCI were classified into HBR and non-HBR based on the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria and were monitored during their hospitalization.Results: A total of 314 patients were enrolled: 103 HBR (32.8%) and 211 (67.2%) non-HBR.In-hospital all-cause mortality (17.4% vs. 2.84%, p < 0.001), cardiovascular mortality (12.6% vs. 2.84%, p < 0.001) and major bleeding events (15.5% vs. 1.89%, p < 0.001) were significantly higher in the HBR group.The trans-femoral access during PCI (OR = 3.524, 95% CI: 1.035-11.991,p = 0.044) and the baseline estimated glomerular filtration rate (eGFR) (OR = 0.966, 95% CI: 0.938-0.996,p = 0.027) were the only independent predictors of severe bleeding.More specifically, an e-GFR value ≤ 50 ml/min was calculated to predict in-hospital major bleeding complications in HBR patients with 87.5% sensitivity and 64.37% specificity. Conclusions:In-hospital all-cause mortality, cardiovascular mortality, and major bleeding events were significantly higher in HBR patients with an ACS compared to non-HBR patients.HBR patients with baseline impaired renal function should be carefully monitored for severe bleeding complications. Key words: percutaneous coronary intervention, bleeding, high bleeding risk, acute coronary syndrome. S u m m a r yThis study is a real-world registry of high bleeding risk patients with an acute coronary syndrome treated with percutaneous coronary intervention and stent implantation.In-hospital all-cause mortality, cardiovascular mortality, and major bleeding complications are significantly higher in these patients compared to non-high bleeding risk.Transfemoral access during revascularization and baseline impaired kidney function are independent predictors of major bleeding in high bleeding risk patients.An estimated glomerular filtration rate value ≤ 50 ml/min was calculated to predict in-hospital major bleeding events with 87.5% sensitivity and 64.37% specificity.

Source: Advances in Interventional Cardiology