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CC BY-NC-ND 4.0 · Thromb Haemost
DOI: 10.1055/a-2773-5644
Original Article: Coagulation and Fibrinolysis

Prognostic Value of BARC-defined Bleeding in East Asian Acute Myocardial Infarction Patients: Evidence from Multicentre Registries in Korea and Japan

Authors

  • Satoshi Honda    ‡

    1   Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan

  • Kyung Hoon Cho   ‡

    2   Department of Cardiology, Chonnam National University Hospital and Medical School, Gwangju, South Korea

  • Sang Yeub Lee

    3   Department of Cardiology, Chung-Ang University Hospital, Seoul, South Korea

  • Misa Takegami

    4   Department of Public Health and Health Policy, Graduated School of Medicine, University of Tokyo, Tokyo, Japan

  • Kensaku Nishihira

    5   Department of Cardiovascular Medicine, Miyazaki Medical Association Hospital, Miyazaki, Japan

  • Sunao Kojima

    6   Department of Internal Medicine, Sakurajyuji Yatsushiro Rehabilitation Hospital, Kumamoto, Japan

  • Yasuhide Asaumi

    1   Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan

  • Mike Saji

    7   Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan

  • Jun Yamashita

    8   Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan

  • Kiyoshi Hibi

    9   Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan

  • Jun Takahashi

    10   Department of Cardiovascular Medicine, Tohoku University, Sendai, Japan

  • Yasuhiko Sakata

    1   Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan

  • Morimasa Takayama

    11   Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan

  • Tetsuya Sumiyoshi

    11   Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan

  • Teruo Noguchi

    1   Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan

  • Hisao Ogawa

    12   Kumamoto University, Kumamoto, Japan

  • Doo Sun Sim

    2   Department of Cardiology, Chonnam National University Hospital and Medical School, Gwangju, South Korea

  • Hyun Kuk Kim

    13   Department of Cardiology, Chosun University Hospital, Gwangju, South Korea

  • Weon Kim

    14   Division of Cardiology, Kyung Hee University Medical Center, Seoul, South Korea

  • Young Keun Ahn

    2   Department of Cardiology, Chonnam National University Hospital and Medical School, Gwangju, South Korea

  • Myung Ho Jeong

    2   Department of Cardiology, Chonnam National University Hospital and Medical School, Gwangju, South Korea
    15   Heart Center of Gwangju Veterans Hospital, Gwangju, South Korea

  • Satoshi Yasuda

    10   Department of Cardiovascular Medicine, Tohoku University, Sendai, Japan

Funding Information This work was supported in part by the First Incentive Payment for Medical Technology and research from the Naohiko Miyata-Asahi Intecc Foundation for Medical Technology. The JAMIR was planned by the Japan Cardiovascular Research Foundation and funded by Daiichi Sankyo Co., Ltd. KAMIR was funded by the Research Program of Korea Centers for Disease Control and Prevention (2016-EER6304–02).
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Graphical Abstract

Abstract

Background

The Bleeding Academic Research Consortium (BARC) classification was proposed to standardize bleeding endpoint definitions and reports in cardiovascular clinical trials. However, its prognostic value has not been fully validated in East Asian patients with acute myocardial infarction (AMI) who have a higher bleeding risk than Western populations do.

Methods

We analyzed bleeding events (types 2 or 3) based on the BARC classification in 13,657 patients with AMI (mean age 64.9 ± 12.7 years) from nationwide prospective registries in Japan and Korea. The primary endpoint was all-cause mortality during the 1-year clinical follow-up.

Results

During the 1-year follow-up, BARC type 2 or 3 bleeding occurred in 5.5% of the patients (n = 759). Patients who experienced BARC type 2 or 3 bleeding had a significantly higher risk of mortality compared with those without bleeding (hazard ratio [HR] 4.1, 95% confidence interval [CI] 3.4–4.8, p < 0.001). The risk of mortality was higher in BARC type 3 (HR 6.4, 95% CI 5.1–7.9) than in type 2 bleeding (HR 2.4, 95% CI 1.8–3.1). BARC type 2 or 3 bleeding remained significantly associated with increased mortality after adjustment (adjusted HR 1.9, 95% CI 1.5–2.5, p < 0.001). Similar associations with mortality were observed when each BARC classification (type 2 and 3) was analyzed individually.

Conclusion

In East Asian patients with AMI, BARC-defined bleeding events were significantly associated with increased mortality. These findings support the adoption of the BARC classification to predict mortality, particularly in East Asian patients with AMI.

Keywords

BARC - East Asians - acute myocardial infarction - bleeding event - mortality

Data Availability Statement

The deidentified participant data will not be shared.


‡ These authors contributed equally to this work.


Supplementary Material



Publication History

Received: 09 May 2025

Accepted after revision: 15 December 2025

Article published online:
06 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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