Are the ARC-HBR criteria associated with major bleeding and ischaemic events in an all-comer AMI population? : Insights from the MINAP and SWEDEHEART registries
Weight, Nicholas ; von Koch, Sacharias LU
; Mohammad, Moman A
LU
; Rashid, Muhammad
; Dafaalla, Mohamed
; Erlinge, David
LU
and Mamas, Mamas A
(2026)
In European Heart Journal: Acute Cardiovascular Care
p.1-15
- Abstract
BACKGROUND: A significant proportion of acute myocardial infarction (AMI) patients have characteristics of high-bleeding -risk (HBR). Their influence on ischaemic and bleeding-events in AMI all-comers is not well described.
METHODS: AMI Patients in England and Wales (E&W), and Sweden between 2005 and 2019 were included from MINAP and SWEDEHEART national registries. Patients were categorised according to the Academic Research Consortium for HBR criteria (ARC-HBR). Primary outcomes were adjusted risk of major adverse cardiovascular events (MACE; admission with reinfarction and cardiovascular death) and major-bleeding events (death or readmission with bleeding), secondary outcomes were all-cause and cardiovascular mortality,... (More)
BACKGROUND: A significant proportion of acute myocardial infarction (AMI) patients have characteristics of high-bleeding -risk (HBR). Their influence on ischaemic and bleeding-events in AMI all-comers is not well described.
METHODS: AMI Patients in England and Wales (E&W), and Sweden between 2005 and 2019 were included from MINAP and SWEDEHEART national registries. Patients were categorised according to the Academic Research Consortium for HBR criteria (ARC-HBR). Primary outcomes were adjusted risk of major adverse cardiovascular events (MACE; admission with reinfarction and cardiovascular death) and major-bleeding events (death or readmission with bleeding), secondary outcomes were all-cause and cardiovascular mortality, up-to five-years, with Cox-regression models, adjusted for baseline demographics. Secondary analyses evaluated medically and invasively-managed patients.
RESULTS: 563,251 AMI patients from E&W (39% HBR, median follow-up 1901 days) and 189,102 from Sweden (39% HBR, 2084 days) were included. Risk of MACE (E&W: adjusted Hazard ratio (aHR) 2.99, 95% CI [2.95-3.02], Sweden: 2.68[2.64-2.73]) and major- bleeding events (E&W: 2.28[2.21-2.35], Sweden: 2.71[2.58-2.85]) was higher in HBR-patients (all P<0.001). MACE was more likely in medically-managed (E&W: 3.24[3.19-3.29], Sweden: 2.31 [2.26-2.37]) and invasively-managed (E&W: 2.94[2.88-3.00], Sweden: 1.98[1.92-2.04]) HBR-patients (both P<0.001), as were major-bleeding events; medical (E&W: 2.28[2.19-2.37], Sweden: 1.35[1.25-1.45]) (both P<0.001); invasive groups (E&W: 2.25[2.15-2.35], P<0.001), Sweden: 1.41[1.29-1.54], P=0.024).
CONCLUSIONS: In an all-comer AMI population, 1 in 3 meet HBR criteria. HBR patients had significantly higher rates of MACE and major bleeding, persisting whether managed invasively or medically. We show that the ARC-HBR criteria are associated with increased bleeding and MACE risk in all-comer AMI patients.
(Less)
- author
- Weight, Nicholas
; von Koch, Sacharias
LU
; Mohammad, Moman A
LU
; Rashid, Muhammad
; Dafaalla, Mohamed
; Erlinge, David
LU
and Mamas, Mamas A
- organization
- publishing date
- 2026-02-19
- type
- Contribution to journal
- publication status
- epub
- subject
- in
- European Heart Journal: Acute Cardiovascular Care
- article number
- zuag025
- pages
- 1 - 15
- publisher
- Oxford University Press
- external identifiers
-
- pmid:41717847
- ISSN
- 2048-8734
- DOI
- 10.1093/ehjacc/zuag025
- language
- English
- LU publication?
- yes
- additional info
- © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.
- id
- d7313f70-2b4c-4f40-a2b4-79f85a0f9cfc
- date added to LUP
- 2026-04-13 10:11:25
- date last changed
- 2026-04-13 14:45:14
@article{d7313f70-2b4c-4f40-a2b4-79f85a0f9cfc,
abstract = {{<p>BACKGROUND: A significant proportion of acute myocardial infarction (AMI) patients have characteristics of high-bleeding -risk (HBR). Their influence on ischaemic and bleeding-events in AMI all-comers is not well described.</p><p>METHODS: AMI Patients in England and Wales (E&W), and Sweden between 2005 and 2019 were included from MINAP and SWEDEHEART national registries. Patients were categorised according to the Academic Research Consortium for HBR criteria (ARC-HBR). Primary outcomes were adjusted risk of major adverse cardiovascular events (MACE; admission with reinfarction and cardiovascular death) and major-bleeding events (death or readmission with bleeding), secondary outcomes were all-cause and cardiovascular mortality, up-to five-years, with Cox-regression models, adjusted for baseline demographics. Secondary analyses evaluated medically and invasively-managed patients.</p><p>RESULTS: 563,251 AMI patients from E&W (39% HBR, median follow-up 1901 days) and 189,102 from Sweden (39% HBR, 2084 days) were included. Risk of MACE (E&W: adjusted Hazard ratio (aHR) 2.99, 95% CI [2.95-3.02], Sweden: 2.68[2.64-2.73]) and major- bleeding events (E&W: 2.28[2.21-2.35], Sweden: 2.71[2.58-2.85]) was higher in HBR-patients (all P<0.001). MACE was more likely in medically-managed (E&W: 3.24[3.19-3.29], Sweden: 2.31 [2.26-2.37]) and invasively-managed (E&W: 2.94[2.88-3.00], Sweden: 1.98[1.92-2.04]) HBR-patients (both P<0.001), as were major-bleeding events; medical (E&W: 2.28[2.19-2.37], Sweden: 1.35[1.25-1.45]) (both P<0.001); invasive groups (E&W: 2.25[2.15-2.35], P<0.001), Sweden: 1.41[1.29-1.54], P=0.024).</p><p>CONCLUSIONS: In an all-comer AMI population, 1 in 3 meet HBR criteria. HBR patients had significantly higher rates of MACE and major bleeding, persisting whether managed invasively or medically. We show that the ARC-HBR criteria are associated with increased bleeding and MACE risk in all-comer AMI patients.</p>}},
author = {{Weight, Nicholas and von Koch, Sacharias and Mohammad, Moman A and Rashid, Muhammad and Dafaalla, Mohamed and Erlinge, David and Mamas, Mamas A}},
issn = {{2048-8734}},
language = {{eng}},
month = {{02}},
pages = {{1--15}},
publisher = {{Oxford University Press}},
series = {{European Heart Journal: Acute Cardiovascular Care}},
title = {{Are the ARC-HBR criteria associated with major bleeding and ischaemic events in an all-comer AMI population? : Insights from the MINAP and SWEDEHEART registries}},
url = {{http://dx.doi.org/10.1093/ehjacc/zuag025}},
doi = {{10.1093/ehjacc/zuag025}},
year = {{2026}},
}