Coronary disease & ACSCohort study
Are the ARC-HBR criteria associated with major bleeding and ischaemic events in an all-comer acute myocardial infarction (AMI) population? Insights from the MINAP and SWEDEHEART registries
- national registries
Authors' conclusion
In an all-comer AMI population, one in three 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.
Study context
- Population
- AMI patients in England and Wales (E&W) and Sweden between 2005 and 2019AMI patients included from MINAP and SWEDEHEART national registries · E&W (39% high bleeding risk (HBR), median follow-up of 1901 days) 563,251 · Sweden (39% HBR, 2084 days) 189,102
- Exposure
- Patients were categorized according to the Academic Research Consortium for HBR criteria (ARC-HBR)
- Outcome
- Adjusted risk of MACE (admission with reinfarction and cardiovascular death) and major bleeding events (death or readmission with bleeding)
- Follow-up
- Up to 5 years
Main finding
As reported in the abstract
HBR patientsAdjusted hazard ratio (95% CI)P value
MACE, E&W
2.99(2.95–3.02)
P < 0.001MACE, Sweden
2.68(2.64–2.73)
P < 0.001major bleeding, E&W
2.28(2.21–2.35)
P < 0.001major bleeding, Sweden
2.71(2.58–2.85)
P < 0.001Observational data: associations, not effects.
Secondary outcomes
Major adverse cardiovascular events (MACE), medically and invasively managed patients (secondary analyses)
| Comparison | aHR (CI) | P value | |
|---|---|---|---|
| HBR patients · medically managed, E&W | 3.24 (3.19–3.29) | P < 0.001 | |
| HBR patients · medically managed, Sweden | 2.31 (2.26–2.37) | P < 0.001 | |
| HBR patients · invasively managed, E&W | 2.94 (2.88–3.00) | P < 0.001 | |
| HBR patients · invasively managed, Sweden | 1.98 (1.92–2.04) | P < 0.001 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Major bleeding events, medically and invasively managed patients (secondary analyses)
| Comparison | aHR (CI) | P value | |
|---|---|---|---|
| HBR patients · medical, E&W | 2.28 (2.19–2.37) | P < 0.001 | |
| HBR patients · medical, Sweden | 1.35 (1.25–1.45) | P < 0.001 | |
| HBR patients · invasive, E&W | 2.25 (2.15–2.35) | P < 0.001 | |
| HBR patients · invasive, Sweden | 1.41 (1.29–1.54) | P = 0.024 | |
| 0.512Adjusted hazard ratio (log scale) |
Original publication
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. Eur Heart J Acute Cardiovasc Care. Published 19 February 2026. doi:10.1093/ehjacc/zuag025
Summarised from the published abstract; every number is checked against it