Impact of Multiple Cardiovascular Events on Long‐Term Outcomes and Bleeding Risk in Patients With Acute Coronary Syndrome: A Nationwide Population‐Based Cohort Study
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 Nati...
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Wiley
2025-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.039290 |
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| author | Chih‐Wei Chen Yi‐Cheng Lin Donna Shu‐Han Lin Chia‐Li Chang Chun‐Yao Huang Jaw‐Wen Chen Shing‐Jong Lin Yu‐Hsuan Joni Shao Chien‐Yi Hsu |
| author_facet | Chih‐Wei Chen Yi‐Cheng Lin Donna Shu‐Han Lin Chia‐Li Chang Chun‐Yao Huang Jaw‐Wen Chen Shing‐Jong Lin Yu‐Hsuan Joni Shao Chien‐Yi Hsu |
| author_sort | Chih‐Wei Chen |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-8d305a4f5b634c0ba17ae65d501b129f |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-8d305a4f5b634c0ba17ae65d501b129f2025-08-20T03:58:49ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-07-01141310.1161/JAHA.124.039290Impact of Multiple Cardiovascular Events on Long‐Term Outcomes and Bleeding Risk in Patients With Acute Coronary Syndrome: A Nationwide Population‐Based Cohort StudyChih‐Wei Chen0Yi‐Cheng Lin1Donna Shu‐Han Lin2Chia‐Li Chang3Chun‐Yao Huang4Jaw‐Wen Chen5Shing‐Jong Lin6Yu‐Hsuan Joni Shao7Chien‐Yi Hsu8Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine Taipei Medical University Hospital Taipei TaiwanDepartment of Pharmacy Taipei Medical University Hospital Taipei TaiwanDivision of Cardiology, Department of Internal Medicine Shin Kong Wu Ho‐Su Memorial Hospital Taipei TaiwanHealth Data Analytics and Statistics Center, Office of Data Science Taipei Medical University Taipei TaiwanDivision of Cardiology and Cardiovascular Research Center, Department of Internal Medicine Taipei Medical University Hospital Taipei TaiwanDivision of Cardiology and Cardiovascular Research Center, Department of Internal Medicine Taipei Medical University Hospital Taipei TaiwanDivision of Cardiology and Cardiovascular Research Center, Department of Internal Medicine Taipei Medical University Hospital Taipei TaiwanHealth Data Analytics and Statistics Center, Office of Data Science Taipei Medical University Taipei TaiwanDivision of Cardiology and Cardiovascular Research Center, Department of Internal Medicine Taipei Medical University Hospital Taipei TaiwanBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.124.039290acute coronary syndrome (ACS)Asian populationbleeding riskmajor adverse cardiovascular events (MACE)tailored antiplatelet strategy |
| spellingShingle | Chih‐Wei Chen Yi‐Cheng Lin Donna Shu‐Han Lin Chia‐Li Chang Chun‐Yao Huang Jaw‐Wen Chen Shing‐Jong Lin Yu‐Hsuan Joni Shao Chien‐Yi Hsu Impact of Multiple Cardiovascular Events on Long‐Term Outcomes and Bleeding Risk in Patients With Acute Coronary Syndrome: A Nationwide Population‐Based Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute coronary syndrome (ACS) Asian population bleeding risk major adverse cardiovascular events (MACE) tailored antiplatelet strategy |
| title | Impact of Multiple Cardiovascular Events on Long‐Term Outcomes and Bleeding Risk in Patients With Acute Coronary Syndrome: A Nationwide Population‐Based Cohort Study |
| title_full | Impact of Multiple Cardiovascular Events on Long‐Term Outcomes and Bleeding Risk in Patients With Acute Coronary Syndrome: A Nationwide Population‐Based Cohort Study |
| title_fullStr | Impact of Multiple Cardiovascular Events on Long‐Term Outcomes and Bleeding Risk in Patients With Acute Coronary Syndrome: A Nationwide Population‐Based Cohort Study |
| title_full_unstemmed | Impact of Multiple Cardiovascular Events on Long‐Term Outcomes and Bleeding Risk in Patients With Acute Coronary Syndrome: A Nationwide Population‐Based Cohort Study |
| title_short | Impact of Multiple Cardiovascular Events on Long‐Term Outcomes and Bleeding Risk in Patients With Acute Coronary Syndrome: A Nationwide Population‐Based Cohort Study |
| title_sort | impact of multiple cardiovascular events on long term outcomes and bleeding risk in patients with acute coronary syndrome a nationwide population based cohort study |
| topic | acute coronary syndrome (ACS) Asian population bleeding risk major adverse cardiovascular events (MACE) tailored antiplatelet strategy |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.039290 |
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