Predictive Ability of the Academic Research Consortium High Bleeding Risk Criteria in Patients Undergoing Percutaneous Coronary Intervention According to Body Mass Index

Abstract

Background

Whether the high bleeding risk (HBR) criteria of the Academic Research Consortium (ARC) have a consistent predictive ability across different categories of body mass index (BMI) remains unclear.

Methods

Consecutive patients undergoing percutaneous coronary intervention (PCI) between 2012 and 2019 at Mount Sinai Hospital (New York, USA) were stratified into five BMI categories (18.5–24.9 kg/m² [normoweight], 25–29.9 kg/m² [overweight], 30–34.9 kg/m² [Class I obesity], 35–39.9 kg/m² [Class II obesity], and BMI ≥ 40 kg/m² [Class III obesity]) and by HBR status. The primary outcome was major bleeding at 1 year after PCI.

Results

Among 16,123 patients, normoweight, overweight, class I, class II, and class III obesity were found in 23.7%, 41%, 24.5%, 9.3%, 4.8% of patients, respectively. Fulfillment of the ARC-HBR criteria ranged between 34.4% and 48.5% across these BMI categories. One-year rates of major bleeding was 6% in normoweight patients (reference), 4.1% in overweight (adj.HR 0.73, 95% CI 0.60–0.88), 3.5% in class I (adj.HR 0.62, 95% CI 0.49–0.77), 4.2% in class II (adj.HR 0.72, 95% CI 0.54–0.96), and 4.9% in class III (adj.HR 0.83, 95% CI 0.58–1.18) obesity. Consistently across the 5 BMI categories, the fulfillment of ARC-HBR criteria was related with > 4% rates of major bleeding at 1-year and with ≥ 2 times risk increase of major bleeding (p_int = 0.177).

Conclusions

The presence of the ARC-HBR criteria predicted a significantly increased risk of major bleeding consistently in each BMI category.