Validation of BARC Bleeding Criteria in Patients With Acute Coronary Syndromes
The TRACER Trial
Pascal Vranckx, Harvey D. White, Zhen Huang, Kenneth W. Mahaffey, Paul W. Armstrong, Frans Van de Werf, David J. Moliterno, Lars Wallentin, Claes Held, Philip E. Aylward, Jan H. Cornel, Christoph Bode, Kurt Huber, José C. Nicolau, Witold Ruzyllo, Robert A. Harrington and Pierluigi Tricoci
BARC Criteria in ACS Patients Without ST-Segment Elevation: Clinical Validation
This study evaluated the impact of bleeding classified with the BARC scale on mortality in a cohort of patients with non–ST-segment-elevation acute coronary syndrome (N = 12,944) treated according to current clinical practice and enrolled in the TRACER trial. The bleeds classified as BARC grades 2, 3, or 4 were independently associated with an increased risk of mortality, which gradually rose up to 1 year following a bleeding event with an escalating BARC-graded severity of bleeding observed for noncoronary artery bypass graft–related bleeding. The hazard of death associated with BARC grade 3 criteria was similar in magnitude compared with TIMI (major or minor) and GUSTO (moderate or severe) bleeding criteria. The BARC criteria captured a higher proportion of major bleeding compared with both the GUSTO and the TIMI scales alone. ACS = acute coronary syndrome; BARC = Bleeding Academic Research Consortium; GUSTO = Global Strategies for Opening Occluded Coronary Arteries; TIMI = Thrombolysis In Myocardial Infarction; TRACER = Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome.