Validation of the Bleeding Academic Research Consortium Definition of Bleeding in Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention
Background—The Bleeding Academic Research Consortium (BARC) has recently proposed a unified definition of bleeding in patients receiving antithrombotic therapy. We investigated the relationship between bleeding events as defined by BARC and 1-year mortality in patients undergoing percutaneous coronary intervention (PCI) and assessed whether the BARC bleeding definition is superior to existing bleeding definitions regarding mortality prediction in patients after PCI procedures.
Methods and Results—This study represents a patient level pooled analysis of 12459 patients recruited in 6 randomized trials of patients undergoing PCI. Bleeding events were assessed using BARC, Thrombolysis in Myocardial Infarction (TIMI) and Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events (REPLACE-2) trial criteria. The primary outcome was 1-year mortality. Bleeding occurred in 1233 patients (9.9%) according to BARC (679 patients or 5.4% with BARC class ≥2 bleeding) in 374 patients (3.0%) according to TIMI and 491 patients (3.9%) according to REPLACE-2 criteria. There were 340 deaths (2.7%) over the first year following PCI. A BARC class ≥2 bleeding was associated with a significant increase in the 1-year mortality (adjusted hazard ratio=2.72, 95% confidence interval [CI] 2.03-3.63). The predictivity of a multivariable model for 1-year mortality was significantly improved after inclusion of bleeding defined according to BARC to an extent comparable to that provided by TIMI and REPLACE-2 criteria.
Conclusions—The present study demonstrated a close association between bleeding events defined according to BARC and 1-year mortality after PCI.
- Received August 6, 2011.
- Accepted January 17, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited