Predictability of HAS-BLED and HEMORR2HAGES Bleeding Risk Scores After Percutaneous Coronary Interventions

Background. Multiple scores have been developed to estimate the bleeding risk. Of these scores, the most frequently used are the HAS-BLED and the HEMORR2HAGES. These scores were nevertheless developed to define the risk of bleeding after anticoagulation for atrial fibrillation. Little data is available on their prediction in patients after percutaneous coronary intervention (PCI). Aims. The study aims to assess and compare the predictability of HAS-BLED and HEMORR2HAGES bleeding risk scores in all-comer patients treated by PCI. We consider the PARIS score which is dedicated to PCI patients as a comparator. The scores were calculated at baseline and compared with the incidence of events during a 2-year clinical follow-up. Methods. Between 2015 and 2017, all consecutive patients undergoing PCI were prospectively included and the bleeding scores were calculated accordingly. For each score, patients were divided into 3 tertiles by risk. Primary endpoints were hierarchical major bleeding events as defined by the Bleeding Academic Research Consortium (BARC) grade 3-5, and ARC patient-oriented major adverse cardiac events (POCE) at 2-year follow-up. Results. Follow-up was complete in 1,080 patients. At 2-year follow-up, 189 patients (17.5%) experienced any bleeding, of which 48 (4.4%) were BARC 3 and 5. All bleeding risk scores demonstrated a significant ability to predict bleeding events. The HEMORR2HAGES score (c- statistic: 0.73) tended to be more effective than the HAS BLED score (c-stat: 0.66, p=0.07) and the PARIS score (c-stat: 0.66, p=0.06) in predicting the risk of major bleeding. Patients in the high-risk bleeding groups experienced more POCE. Conclusions. HEMORR2HAGES, HAS-BLED, and PARIS risk scores demonstrated a good ability to predict bleeding events after PCI. High bleeding risk patients are at higher ischemic risk and have an increased mortality during a 2-year follow-up