Impact of the Japanese Version of High Bleeding Risk Criteria on Clinical Outcomes in Patients with ST-segment Elevation Myocardial Infarction

J Atheroscler Thromb. 2024 Jun 1;31(6):917-930. doi: 10.5551/jat.64445. Epub 2023 Dec 14.

Abstract

Aims: Bleeding complications are often observed in patients with ST-segment elevation myocardial infarction (STEMI). Although the Japanese version of the high bleeding risk criteria (J-HBR) were established, it has not been sufficiently validated in patients with STEMI. This retrospective study aims to examine whether J-HBR is associated with cardiovascular and bleeding events in patients with STEMI.

Methods: We included 897 patients with STEMI and divided them into the J-HBR group (n=567) and the non-J-HBR group (n=330). The primary endpoint was the major adverse cardiovascular events (MACE), defined as the composite of all-cause death, non-fatal myocardial infarction, ischemic stroke, and systemic embolism. Another primary endpoint was total bleeding events defined as type 3 or 5 bleeding events as defined by the Bleeding Academic Research Consortium .

Results: During the median follow-up duration of 573 days, 187 MACE and 141 total bleeding events were observed. The Kaplan-Meier curves showed that MACE and total bleeding events were more frequently observed in the J-HBR group than in the non-J-HBR group (p<0.001). Multivariate Cox hazard analysis revealed that after controlling for multiple confounding factors, the J-HBR group was significantly associated with MACE (hazard ratio [HR] 4.676, 95% confidence interval (CI) 2.936-7.448, p<0.001) and total bleeding events (HR 6.325, 95% CI 3.376-11.851, p<0.001).

Conclusions: J-HBR is significantly associated with MACE and total bleeding events in patients with STEMI. This study validated J-HBR as a risk marker for bleeding events and suggests J-HBR as a potential risk marker for MACE in patients with STEMI.

Keywords: Acute myocardial infarction; High bleeding risk; J-HBR; Major cardiovascular events; ST-segment elevation myocardial infarction.

MeSH terms

  • Aged
  • Female
  • Follow-Up Studies
  • Hemorrhage* / diagnosis
  • Hemorrhage* / etiology
  • Humans
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention
  • Prognosis
  • Retrospective Studies
  • Risk Assessment / methods
  • Risk Factors
  • ST Elevation Myocardial Infarction* / complications
  • ST Elevation Myocardial Infarction* / diagnosis