Validation of BARC Bleeding Criteria in Patients with Acute Coronary Syndromes the TRACER Trial

Pascal Vranckx, Harvey D. White, Zhen Huang, Kenneth W. Mahaffey, Paul W. Armstrong, Frans Van De Werf, David J. Moliterno, Lars Wallentin, Claes Held, Philip E. Aylward, Jan H. Cornel, Christoph Bode, Kurt Huber, José C. Nicolau, Witold Ruzyllo, Robert A. Harrington, Pierluigi Tricoci

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35 Citations (Scopus)

Abstract

Background The Bleeding Academic Research Consortium (BARC) scale has been proposed to standardize bleeding endpoint definitions and reporting in cardiovascular trials. Validation in large cohorts of patients is needed. Objectives This study sought to investigate the relationship between BARC-classified bleeding and mortality and compared its prognostic value against 2 validated bleeding scales: TIMI (Thrombolysis In Myocardial Infarction) and GUSTO (Global Use of Strategies to Open Occluded Arteries). Methods We analyzed bleeding in 12,944 patients with acute coronary syndromes without ST-segment elevation, with or without early invasive strategy. The main outcome measure was all-cause death. Results During follow-up (median: 502 days), noncoronary artery bypass graft (CABG) bleeding occurred in 1,998 (15.4%) patients according to BARC (grades 2, 3, or 5), 484 (3.7%) patients according to TIMI minor/major, and 514 (4.0%) patients according to GUSTO moderate/severe criteria. CABG-related bleeding (BARC 4) occurred in 155 (1.2%) patients. Patients with BARC (2, 3, or 4) bleeding had a significant increase in risk of death versus patients without bleeding (BARC 0 or 1); the hazard was highest in the 30 days after bleeding (hazard ratio: 7.35; 95% confidence interval: 5.59 to 9.68; p < 0.0001) and remained significant up to 1 year. The hazard of mortality increased progressively with non-CABG BARC grades. BARC 4 bleeds were significantly associated with mortality within 30 days (hazard ratio: 10.05; 95% confidence interval: 5.41 to 18.69; p < 0.0001), but not thereafter. Inclusion of BARC (2, 3, or 4) bleeding in the 1-year mortality model with baseline characteristics improved it to an extent comparable to TIMI minor/major and GUSTO moderate/severe bleeding. Conclusions In patients with acute coronary syndromes without ST-segment elevation, bleeding assessed with the BARC scale was significantly associated with risk of subsequent death up to 1 year after the event and risk of mortality increased gradually with higher BARC grades. Our results support adoption of the BARC bleeding scale in ACS clinical trials.

Original languageEnglish
Pages (from-to)2135-2144
Number of pages10
JournalJournal of the American College of Cardiology
Volume67
Issue number18
DOIs
Publication statusPublished or Issued - 10 May 2016

Keywords

  • Bleeding Academic Research Consortium
  • aspirin
  • clopidogrel
  • mortality
  • vorapaxar

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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