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

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.