Risk score predicts bleeding after discharge from PCI

LAS VEGAS — The BRIC-ACS score accurately predicted postdischarge bleeding in patients who underwent PCI, according to findings presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.

Yundai Chen, MD, PhD, Junjie Yang, MD, both from the General Hospital of the Chinese People’s Liberation Army in Beijing, and colleagues assessed the effect of postdischarge bleeding, defined as Bleeding Academic Research Consortium (BARC) grade 2, 3 or 5, on MACE and developed a risk score to predict postdischarge bleeding in patients with ACS who had PCI.

Chen and colleagues analyzed 2,496 consecutive patients from 29 Chinese tertiary hospitals. All received dual antiplatelet therapy consisting of aspirin and clopidogrel or ticagrelor (Brilinta, AstraZeneca) after PCI. The findings were simultaneously published in Catheterization and Cardiovascular Interventions.

“Bleeding is an important issue for patients post-PCI procedure,” Yang said during a presentation. “The incidence of bleeding in Chinese patients has increased dramatically in recent decades.”

Among the 2,381 patients who completed 1-year follow-up, 4.9% had postdischarge bleeding and 3.3% had MACE after discharge, according to the researchers.

Patients who had postdischarge bleeding had higher risk for MACE, defined as all-cause mortality, nonfatal MI, urgent coronary revascularization or ischemic stroke, than patients who did not (7.7% vs. 3.1%; adjusted HR = 2.59; 1.17-5.74), according to the researchers.

The BRIC-ACS score accurately predicted postdischarge bleeding in patients who underwent PCI, according to findings presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.

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Postdischarge bleeding was more common in patients on ticagrelor compared with those on clopidogrel (8% vs. 4.4%; aHR = 2.05; 95% CI, 1.17-3.6), but there was no difference in MACE risk by antiplatelet choice (ticagrelor, 2%; clopidogrel, 3.4%; aHR = 0.7; 95% CI, 0.25-1.93), Chen and colleagues found.

Patients with post-discharge bleeding were older (63 years vs. 61 years) and were more likely to be women (34.2% vs. 23%), Yang said.

The BRIC-ACS score developed by the researchers to predict postdischarge bleeding had eight components: female sex, multivessel lesions, hypertension, prior peptic ulcer, use of ticagrelor, BMI, hemoglobin, triglycerides and LDL, Yang said.

When the cohort was divided into tertiles by BRIC-ACS score, the highest tertile had a 17.3% rate of post-discharge bleeding compared with 1.2% for the lowest tertile (P for trend < .0001), according to the researchers.

The score had a C-statistic of 0.67 (95% CI, 0.62-0.73), and the C-statistic was 0.7 or higher in patients who had STEMI, patients who had non-STEMI, patients with diabetes and patients who received more than two drug-eluting stents.

“The BRIC-ACS study is the first-ever real-world registry study concerning post-discharge bleeding in Chinese patients,” Yang said during the presentation. “BARC grade 2 or more is associated with higher risk for later ischemic events in patients who underwent PCI and are on dual antiplatelet therapy. The BRIC-ACS risk score has good performance for [post-discharge bleeding], especially in patients at high ischemic risk. We are initiating the BRIC-ACS 2 study to make more progress in the future.” – by Erik Swain

References:

Chen Y, et al. Featured Clinical Research I. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 19-22, 2019; Las Vegas.

Chen Y, et al. Catheter Cardiovasc Interv. 2019;doi:10.1002/ccd.28325.

Disclosures: The study was sponsored by Sanofi. The authors report they received no payment from Sanofi directly or indirectly related to the development of publication.