Key result
Multiple risk factors linked to markedly higher ischemic events with minimal increase in bleeding risk.
Why the study?
In patients with MI, risk factors for bleeding and ischaemic events overlap, but their combined effects have scarcely been studied in contemporary real-world settings.
Does the combination of established risk factors increase the risk of ischemic and bleeding outcomes in patients with invasively managed myocardial infarction?
Cohort (n=100,879)
Yes
Does the combination of established risk factors increase the risk of ischemic and bleeding outcomes in patients with invasively managed myocardial infarction?
In patients with myocardial infarction, accumulating risk factors dramatically increases the risk of recurrent ischemic events, whereas major bleeding risk remains low if there is no prior history of major bleeding, supporting more intensive secondary prevention in this subgroup.
Answers are grounded in this paper and cite their sources.
Multiple risk factors flag post-MI patients with high ischemic but low incremental bleeding risk; hypothesis-generating for tailored antithrombotic strategies.
OBJECTIVE: In patients with myocardial infarction (MI), risk factors for bleeding and ischaemic events tend to overlap, but the combined effects of these factors have scarcely been studied in contemporary real-world settings. We aimed to assess the combined associations of established risk factors using nationwide registries. METHODS: Using the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry, patients with invasively managed MI in 2006-2014 were included. Six factors were assessed in relation to cardiovascular death (CVD)/MI/stroke, and major bleeding: age ≥65, chronic kidney disease, diabetes, multivessel disease, prior bleeding and prior MI. RESULTS: We studied 100 879 patients, of whom 20 831 (20.6%) experienced CVD/MI/stroke and 5939 (5.9%) major bleeding, during 3.6 years median follow-up. In adjusted Cox models, all factors were associated with CVD/MI/stroke, and all but prior MI were associated with major bleeding. The majority (53.5%) had ≥2 risk factors. With each added risk factor, there was a marked but gradual increase in incidence of the CVD/MI/stroke. This was seen also for major bleeding, but to a lesser extent, largely driven by prior bleeding as the strongest risk factor. CONCLUSIONS: The majority of patients with MI had two or more established risk factors. Increasing number of risk factors was associated with higher rate of ischaemic events. When excluding patients with prior major bleeding, bleeding incidence rate increased only minimally with increasing number of risk factors. The high ischaemic risk in those with multiple risk factors highlights an unmet need for additional preventive measures.
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Lindholm et al. (2019) conducted a cohort in Myocardial infarction managed invasively (n=100,879). Multiple established risk factors (age ≥65, chronic kidney disease, diabetes, multivessel disease, prior bleeding, prior MI) vs. Fewer or zero risk factors was evaluated on Composite of myocardial infarction, stroke, and cardiovascular death (p=<0.001). An increasing number of overlapping risk factors was associated with a markedly higher rate of ischemic events, while bleeding risk increased only minimally with additional risk factors when excluding patients with prior bleeding.
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