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

Nicholas Weight; Sacharias von Koch; Moman A Mohammad; Muhammad Rashid; Mohamed Dafaalla; David Erlinge; Mamas A Mamas

doi:10.1093/ehjacc/zuag025

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. 2026 Feb 19:zuag025. doi: 10.1093/ehjacc/zuag025. Online ahead of print.

Authors

Nicholas Weight¹, Sacharias von Koch^{2

3}, Moman A Mohammad^{2

3}, Muhammad Rashid^{1

4}, Mohamed Dafaalla¹, David Erlinge^{2

3}, Mamas A Mamas^{1

5}

Affiliations

¹ Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom.
² Division of Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
³ Department of Cardiology, Skåne University Hospital, Lund, Sweden.
⁴ Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom.
⁵ National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK.

PMID: 41717847
DOI: 10.1093/ehjacc/zuag025

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, 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.

Keywords: Acute myocardial infarction; elevated bleeding risk; long-term mortality; quality of care.

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