CBS 2019
CBSMD教育中心
中 文

科学研究

Abstract

Recommended Article

Prevalence, Presentation and Treatment of 'Balloon Undilatable' Chronic Total Occlusions: Insights from a Multicenter US Registry Invasive Coronary Physiology After Stent Implantation: Another Step Toward Precision Medicine Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association Long-Term Outcomes of Biodegradable Versus Second-Generation Durable Polymer Drug-Eluting Stent Implantations for Myocardial Infarction Drug-Coated Balloon Versus Drug-Eluting Stent in Primary Percutaneous Coronary Intervention: A Feasibility Study Systems of Care for ST-Segment–Elevation Myocardial Infarction: A Policy Statement From the American Heart Association ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: A Report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography

Original Research

JOURNAL:Circulation. Article Link

EUROPCR 2019 - ARC Defined High Bleeding Risk in PCI Patients

CBSMD

Pre-reading

Currently available bleeding risk scores are listed in Table 2. PRECISE-DAPT with Class IIb, Evidence A was recommended by ESC in 2017.

These risk scores were developed based on randomized trials with significant heterogeneity with respect to the patient population, such differences highlight the need for a standardized definition of HBR:

1. The differences in eligibility criteria (all-comer, patients at increased bleeding risk) and enrolled patient populations in completed trials are reflected in the differences in bleeding event rates, varies from 3.5-7.3%。

2. Patients unsuitable for long-term DAPT continue to be systematically excluded.

3. Clinical trials of DAPT strategies after stenting have also excluded patients at HBR, with reported major bleeding rates at 1 year varying between 0.3% and 2.8% (Table 1).

4. Subjects at HBR are still underrepresented in contemporary studies.




To optimize the identification and management of patients at high bleeding risk under going PCI, "Defining High Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention: A Consensus Document From the Academic Research Consortium for High Bleeding Risk" proposed the first pragmatic approach to a consistent definition of high bleeding risk in clinical trials evaluating the safety and effectiveness of devices and drug regimens for patients under going PCI. This white paper covers 20 criteria (14 major criteria and 6 minor criteria) which can assist clinicians identify patients with 1 major criterion or 2 minor criteria as high bleeding risk rapidly and make clinical decisions accordingly.