Validation of a high bleeding risk definition in cancer patients undergoing percutaneous coronary intervention

Aims Due to the absence of validated bleeding risk tools in cancer patients undergoing percutaneous coronary intervention (PCI), we aimed to validate an adapted version of the Academic Research Consortium (ARC) High Bleeding Risk (HBR) criteria. Methods and results Consecutive patients with active or remission cancer undergoing PCI between 2012 and 2022 at Mount Sinai Hospital (New York, USA) were included. Patients were considered at HBR if they met at least one of the major ARC-HBR criteria, other than cancer, or two minor criteria. The primary endpoint was a composite of periprocedural in-hospital or post-discharge bleeding at 1 year. The key secondary endpoint was major adverse cardiac and cerebrovascular events (MACCEs), including death, myocardial infarction, or stroke. Of the 2007 cancer patients included in this study, 1142 (56.9%) were classified as HBR. Moderate to severe anaemia was the most prevalent major HBR criterion (35%). At 1 year, the incidence of bleeding was significantly higher in HBR compared with non-HBR patients [10.9 vs. 3.9%, adjusted hazard ratio (HR): 2.36, 95% confidence interval (CI): 1.57–3.53, P < 0.001], mainly driven by higher periprocedural bleeding. Similarly, HBR patients were at higher risk of MACCE (11.0% vs. 3.2%, adjusted HR: 2.78, 95% CI: 1.72–4.47, P < 0.001) and death (8.8% vs. 2.2%, adjusted HR: 3.28, 95% CI: 1.87–5.77, P < 0.001) than non-HBR patients. Conclusion An adapted version of the ARC-HBR criteria, in which cancer is not a major criterion, effectively delineates cancer patients undergoing PCI who are at HBR. Cancer patients at HBR according to this definition also exhibited a higher mortality risk.