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Impact of Multiple Cardiovascular Events on Long-Term Outcomes and Bleeding Risk in Patients With Acute Coronary
Chih-Wei Chen1,2,3,4, Yi-Cheng Lin5,6, Donna Shu-Han Lin7
1Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine Taipei Medical University Hospital Taipei Taiwan.
Insights
Patients experiencing multiple cardiovascular events after acute coronary syndrome (ACS) face higher mortality and bleeding risks. Tailored antiplatelet strategies are crucial for Asian populations to mitigate these risks.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Acute coronary syndrome (ACS) patients have elevated risks for recurrent events and bleeding, especially in Asian populations.
- The long-term consequences of recurrent cardiovascular events and bleeding in ACS patients remain incompletely understood.
Purpose of the Study:
- To investigate the long-term outcomes of patients with acute coronary syndrome (ACS) who experience single versus multiple cardiovascular events.
- To compare mortality rates, bleeding complications, and the association between bleeding and subsequent events in these patient groups.
Main Methods:
- Retrospective cohort study utilizing Taiwan's National Health Insurance Research Database.
- Included 28,086 ACS patients, categorized into single-event (n=17,446) and multiple-event (n=8,756) groups based on events within 2 years, matched for age, sex, and event interval.
Main Results:
- The multiple-event group exhibited higher comorbidity rates and significantly increased 5-year all-cause mortality (34.0% vs. 24.0%) and cardiovascular mortality (11.2% vs. 5.5%).
- Major and minor bleeding rates were substantially higher in the multiple-event group (8.4% vs. 1.6% and 35.5% vs. 7.4%, respectively).
- In the multiple-event group, major bleeding was linked to earlier subsequent cardiovascular events (coefficient=-0.2875, P=0.0325).
Conclusions:
- Patients with ACS experiencing multiple cardiovascular events have poorer prognoses, characterized by higher mortality and bleeding risks.
- Major bleeding events may precipitate further cardiovascular events, underscoring the need for personalized antiplatelet therapy in Asian ACS patients.
Background:
Patients with acute coronary syndrome (ACS) are at high risk for recurrent cardiovascular events and bleeding complications, particularly in Asian populations. The long-term impact of multiple cardiovascular events and bleeding on outcomes remains unclear.
Methods:
Using Taiwan's National Health Insurance Research Database, this retrospective cohort study included 28 086 patients with ACS categorized into single-event and multiple-event groups based on cardiovascular events occurring within 2 years of the index ACS event. After matching for age, sex, and event interval, 8756 patients were assigned to the multiple-event group and 17 446 to the single-event group.
Results:
The multiple-event group had higher comorbidity rates, including hypertension, prior coronary disease, heart failure, stroke, and chronic kidney disease. Over 5 years, the multiple-event group had significantly higher all-cause mortality (34.0% versus 24.0%) and cardiovascular mortality (11.2% versus 5.5%) compared with the single-event group (both P <0.0001). Major (8.4% versus 1.6%) and minor (35.5% versus 7.4%) bleeding rates were also higher (both P <0.0001). Notably, major bleeding persisted beyond 3 months in the multiple-event group, whereas the single-event group showed reduced bleeding after 1 month. In the multiple-event group, each additional major bleeding event was associated with earlier subsequent cardiovascular events (coefficient=-0.2875, P=0.0325).
Conclusions:
Patients with ACS with multiple cardiovascular events have higher rates of all-cause mortality, cardiovascular mortality, and major bleeding than patients with ACS with a single cardiovascular event. Major bleeding may also be associated with the risk of subsequent cardiovascular events, highlighting the importance of implementing a tailored antiplatelet strategy in Asian populations.
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