title: Clinical utility of new bleeding criteria: a prospective study of evaluation for the Bleeding Academic Research Consortium definition of bleeding in patients undergoing percutaneous coronary intervention.
abstract: OBJECTIVE
  The aim of this study was to evaluate the clinical utility of the new bleeding criteria, proposed by the Bleeding Academic Research Consortium (BARC), compared with the old criteria for determining the action of physicians in contact with bleeding events, after percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  The BARC criteria were independently associated with an increased risk of 1-year mortality after PCI, and provided a predictive value, in regard to 1-year mortality. The standardized bleeding definitions will be expected to help the physician to correctly analyze the bleeding events, to select an optimal treatment, and to objectively compare the results of multiple trials and registries.
  
  
  METHODS
  All the patients undergoing PCI from June to September 2012 were prospectively enrolled. Patients who experienced a bleeding event were further classified, based on three different bleeding severity criteria: BARC, Thrombolysis In Myocardial Infarction (TIMI), and Global Use of Strategies To Open coronary arteries (GUSTO). The primary outcome was the occurrence of bleeding events requiring interruption of antiplatelet therapy (IAT) by physicians.
  
  
  RESULTS
  A total of 376 consecutive patients were included in this study. Total bleeding events occurred in 46 patients (12.2%). BARC type ≥2 bleeding occurred in 30 patients (8.0%); however, TIMI major or minor bleeding, and GUSTO moderate or severe bleeding occurred in 6 (1.6%) and 11 patients (2.9%), respectively. Of the 46 patients, 28 (60.9% of patients) required IAT. On receiver-operating characteristic curve analysis, bleeding defined BARC type ≥2 effectively predicted IAT, with a sensitivity of 89.3%, and a specificity of 98.5% (p<0.001), compared with TIMI (sensitivity, 21.4%; specificity, 100%; p<0.001), and GUSTO (sensitivity, 39.3%; specificity, 100%; p<0.001).
  
  
  CONCLUSIONS
  Compared with TIMI and GUSTO, the BARC definition may be a more useful tool for the detection of bleeding with clinical relevance, for patients undergoing PCI.
authors: Regional Cardiocerebrovascular Center, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea.
authors: Jae-Hyuk
authors: JH
authors: Choi
authors: Regional Cardiocerebrovascular Center, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea.
authors: Jeong-Min
authors: JM
authors: Seo
authors: Regional Cardiocerebrovascular Center, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea.
authors: Dong Hyun
authors: DH
authors: Lee
authors: Regional Cardiocerebrovascular Center, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea; Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea. Electronic address: cardiopark@gmail.com.
authors: Kyungil
authors: K
authors: Park
authors: Regional Cardiocerebrovascular Center, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea; Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea.
authors: Young-Dae
authors: YD
authors: Kim
mesh_terms: D000368:Aged; D003661:Decision Support Techniques; D005260:Female; D006470:Hemorrhage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D019106:Postoperative Hemorrhage / Q000175:diagnosis*; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Bleeding Academic Research Consortium; Global Use of Strategies To Open coronary arteries; Thrombolysis In Myocardial Infarction