Are the ARC-HBR criteria associated with major bleeding and ischaemic events in an all-comer AMI population? Insights from the MINAP and SWEDEHEART registries

AIMS: A significant proportion of acute myocardial infarction (AMI) patients have characteristics of high bleeding risk (HBR). Their influence on ischaemic and bleeding events in AMI all-comers is not well described. METHODS AND RESULTS: AMI patients in England and Wales (E&W) and Sweden between 2005 and 2019 were included from MINAP and SWEDEHEART national registries. Patients were categorized according to the Academic Research Consortium for HBR criteria (ARC-HBR). Primary outcomes were adjusted risk of major adverse cardiovascular events (MACE; admission with reinfarction and cardiovascular death) and major bleeding events (death or readmission with bleeding), and secondary outcomes were all-cause and cardiovascular mortality, up to 5 years, with Cox regression models, adjusted for baseline demographics. Secondary analyses evaluated medically and invasively managed patients. A total of 563 251 AMI patients from E&W (39% HBR, median follow-up of 1901 days) and 189 102 from Sweden (39% HBR, 2084 days) were included. The risk of MACE [E&W, adjusted hazard ratio (aHR) 2.99, 95% CI (2.95-3.02); Sweden, 2.68 (2.64-2.73)] and major bleeding events [E&W, 2.28 (2.21-2.35); Sweden, 2.71 (2.58-2.85)] was higher in HBR patients (all P < 0.001). MACE was more likely in medically managed [E&W, 3.24 (3.19-3.29); Sweden, 2.31 (2.26-2.37)] and invasively managed [E&W, 2.94 (2.88-3.00); Sweden, 1.98 (1.92-2.04)] HBR patients (both P < 0.001), as were major bleeding events: medical [E&W, 2.28 (2.19-2.37); Sweden, 1.35 (1.25-1.45)] (both P < 0.001) and invasive groups [E&W, 2.25 (2.15-2.35), P < 0.001; Sweden, 1.41 (1.29-1.54), P = 0.024]. CONCLUSION: In an all-comer AMI population, one in three meet HBR criteria. HBR patients had significantly higher rates of MACE and major bleeding, persisting whether managed invasively or medically. We show that the ARC-HBR criteria are associated with increased bleeding and MACE risk in all-comer AMI patients.