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Title: Balancing the Risks of Recurrent Ischaemic and Bleeding Events in a Stable Post ACS Population.
Austin Authors: Brieger, David;Chew, Derek;Goodman, Shaun;Hammett, Christopher;Lefkovits, Jeffrey;Farouque, Omar ;Atherton, John;Hyun, Karice;D'Souza, Mario
Affiliation: Concord Hospital, and ANZAC Institute University of Sydney, Sydney, NSW, Australia..
Flinders Medical Centre, Adelaide, SA, Australia..
St Michaels Hospital, Toronto, Canada..
Princess Alexandra Hospital, Brisbane, Qld, Australia..
Royal Melbourne Hospital, Melbourne, Vic, Australia..
Austin Health
School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia..
Issue Date: 18-Jul-2022
Date: 2022
Publication information: Heart, Lung & Circulation 2022; 31(10): 1349-1359
Abstract: To better guide decisions regarding antithrombotic treatment in individual patients surviving 6 months following an acute coronary syndrome (ACS) by balancing between subsequent recurrent ischaemic and bleeding risk. Patients surviving 6 months following an ACS were followed in an Australian registry. Ischaemic (composite of cardiovascular death, myocardial infarction or stroke) and bleeding (≥BARC 2) events were collected. A dual binary outcome modelling strategy was used arriving at a common set of variables from which bleeding and ischaemic risk could be independently determined in individual patients. Patients in whom bleeding rates exceeded composite ischaemic event rates during the follow-up period were identified. The cohort comprised 5,905 patients in whom 215 experienced an ischaemic event and 49 a bleeding event. The single set of variables included in both ischaemic and bleeding models (C-statistics 0.71 and 0.72 respectively) included modified TIGRIS1 ischaemic score, mode of revascularisation, history of heart failure, anaemia, multivessel disease, readmission within 6 months of index ACS and age >75. In the majority, ischaemic events were more frequent than bleeding events. In higher risk patients post coronary artery bypass grafting (CABG), bleeding events were more frequent than recurrent ischaemic events. The risk of recurrent ischaemic events exceeds bleeding in most patients followed 6 to 24 months following an ACS. Post CABG patients with comorbidities have a higher risk of bleeding over this period during which time attention should be directed towards modifiable bleeding risk factors including requirement for dual antiplatelet therapy.
DOI: 10.1016/j.hlc.2022.05.043
ORCID: 0000-0003-2821-1451
Journal: Heart, Lung & Circulation
PubMed URL: 35863981
PubMed URL:
Type: Journal Article
Subjects: Acute coronary syndrome
Bleeding risk
Recurrent ischaemic risk
Appears in Collections:Journal articles

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