Prognostic value of risk factors for ischaemic and major bleeding events in chronic coronary syndrome: a SWEDEHEART registry study

AIM: In patients with chronic coronary syndrome, risk factors for ischaemic events and bleeding tend to overlap. However, the combined effects of these factors have scarcely been studied in contemporary real-world settings. METHODS: All patients in Sweden undergoing elective PCI for chronic coronary syndrome between 2006 and 2014 enrolled in the SWEDEHEART registry were included. Six risk factors (age ≥ 65 years, chronic kidney disease, diabetes, multivessel disease (MVD), prior bleeding, and prior acute myocardial infarction (AMI)) were assessed in relation to the risk of ischaemic (cardiovascular death/AMI/stroke) and major bleeding events. RESULTS: We studied 24,051 patients, of whom 59% had ≥ 2 risk factors. During a median follow-up of 3.7 years, 3604 (15.0%) patients experienced ischaemic events and 2076 (8.6%) experienced major bleeding events . Higher numbers of risk factors were associated with a stepwise increase in the incidence of both ischaemic and bleeding events, being more substantial for ischaemic compared to bleeding events. In adjusted Cox models, prior bleeding was of less importance as compared to other risk factors for new ischaemic events. For bleeding events, diabetes, MVD, and prior AMI had limited relevance compared with other risk factors. When excluding patients with prior major bleeding, the increase in ischaemic risk with an increasing number of risk factors was more pronounced, whereas the increase in bleeding incidence was attenuated. . CONCLUSIONS: Among patients with angiographically confirmed chronic coronary syndrome, the majority had two or more established risk factors. An increasing number of risk factors was associated with a higher rate of ischaemic and bleeding events, being more substantial for ischaemic compared to bleeding events.