Advances in Interventional Cardiology
eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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abstract:
Original paper

In-hospital prognosis of high bleeding risk patients with an acute coronary syndrome and successful percutaneous coronary intervention: a single-center real-world registry

Charalampos Kakderis
1
,
Matthaios Didagelos
1
,
Thomas Zegkos
1
,
Konstantinos C. Theodoropoulos
1
,
Antonios Kouparanis
1
,
Dimitra Ioakeimidou
1
,
Anna Iliou
1
,
George Kassimis
2
,
Stergios Tzikas
3
,
Antonios Ziakas
1

  1. First Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
  2. Second Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
  3. Third Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
Adv Interv Cardiol
DOI: https://doi.org/10.5114/aic.2025.156886
Online publish date: 2025/12/10
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Introduction
The management of high bleeding risk (HBR) patients with an acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI) is challenging because these patients combine a severe thrombotic burden with a significant risk of bleeding complications.

Aim
The aim of this study was to quantify the prevalence of HBR patients in a real-world ACS population, identify their in-hospital prognosis, and record their bleeding complications compared to non-HBR patients.

Material and methods
In this real-world registry, patients with an ACS who had undergone successful revascularization with PCI were classified into HBR and non-HBR based on the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria and were monitored during their hospitalization.

Results
A total of 314 patients were enrolled: 103 HBR (32.8%) and 211 (67.2%) non-HBR. In-hospital all-cause mortality (17.4% vs. 2.84%, p < 0.001), cardiovascular mortality (12.6% vs. 2.84%, p < 0.001) and major bleeding events (15.5% vs. 1.89%, p < 0.001) were significantly higher in the HBR group. The trans-femoral access during PCI (OR = 3.524, 95% CI: 1.035–11.991, p = 0.044) and the baseline estimated glomerular filtration rate (eGFR) (OR = 0.966, 95% CI: 0.938–0.996, p = 0.027) were the only independent predictors of severe bleeding. More specifically, an e-GFR value ≤ 50 ml/min was calculated to predict in-hospital major bleeding complications in HBR patients with 87.5% sensitivity and 64.37% specificity.

Conclusions
In-hospital all-cause mortality, cardiovascular mortality, and major bleeding events were significantly higher in HBR patients with an ACS compared to non-HBR patients. HBR patients with baseline impaired renal function should be carefully monitored for severe bleeding complications.

keywords:

percutaneous coronary intervention, bleeding, high bleeding risk, acute coronary syndrome
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