Prognostic Implications of Academic Research Consortium-High Bleeding Risk Criteria in Patients Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention.

BACKGROUND: The prognostic relevance of the Academic Research Consortium-High Bleeding Risk (ARC-HBR) criteria in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is unknown. OBJECTIVES: To assess the ARC-HBR criteria for predicting bleeding and adverse outcomes after CTO PCI. METHODS: The authors retrospectively included all patients who underwent CTO PCI at a tertiary referral center from January 2019 to December 2024. Patients were stratified by ARC-HBR status. Outcomes were in-hospital and 1-year all-cause death, major adverse cardiac and cerebrovascular events (MACCE), and in-hospital Bleeding Academic Research Consortium (BARC) 3-5 bleeding. Multivariable and inverse probability of treatment weighting analyses were performed. RESULTS: Among 2,082 patients, 749 (36.0%) met ARC-HBR criteria. Compared to non-HBR patients, HBR patients had higher in-hospital BARC 3-5 bleeding (15.1% vs 5.9%; p<0.001) and all-cause death (3.7% vs 0.8%; p<0.001). After IPTW adjustment, HBR remained associated with in-hospital BARC 3-5 bleeding (adjusted odds ratio [aOR] 2.44, 95% CI 1.78-3.34; p<0.001) and in-hospital death (aOR 1.77, 95% CI 1.15-2.57; p=0.005), but not in-hospital MACCE (p>0.05). At 1-year follow-up, HBR was associated with all-cause death (adjusted hazard ratio [aHR] 1.45, 95% CI 1.02-2.10; p=0.044) and MACCE (aHR 2.07, 95% CI 1.69-2.51; p<0.001). Among index admission survivors, in-hospital BARC 3-5 bleeding was associated with post-discharge 1-year mortality (aHR 1.72, 95% CI 1.07-2.75; p=0.025), independent of HBR status. CONCLUSIONS: ARC-HBR criteria may identify a vulnerable CTO PCI phenotype at increased bleeding and mortality risk.