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In MI, odds for later ischemic events rise based on number of risk factors
Patients with MI who had multiple established risk factors had a higher rate of ischemic events compared with patients with fewer risk factors, according to findings published in Heart.
But when excluding patients with prior major bleeding, bleeding incidence only grew slightly with increases in risk factors, researchers reported.
Daniel Lindholm, MD, PhD, and colleagues sought to determine the combined associations of established risk factors using nationwide registries.
“Despite recent advances in treatment, patients with MI are still at increased risk for subsequent ischemic events and mortality,” Lindholm, a clinical research physician in research and development at AstraZeneca in Sweden, and colleagues wrote. “While reducing ischemic events, dual inhibition with antiplatelet or anticoagulation is also associated with increased bleeding risk.”
The researchers analyzed data from the SWEDEHEART registry to identify patients with invasively managed MI between 2006 and 2014. Six factors — age 65 years or older, chronic kidney disease, diabetes, multivessel disease, prior bleeding and prior MI — were assessed for their relationship to CV death, MI, stroke and major bleeding.
The cohort included 100,879 patients (mean age, 68 years; 69% men), of whom 20.6% experienced CV death, MI or stroke and 5.9% had major bleeding during a median follow-up period of 3.6 years. Two or more risk factors were recognized in 53.5% of the patients, the researchers wrote.
Each risk factor was associated with elevated risk for CV death/MI/stroke and bleeding (P < .001 for all), Lindholm and colleagues found.
With each additional risk factor, the CV death, MI and stroke risk incidence gradually increased, Lindholm and colleagues wrote. The incidence of major bleeding also incrementally increased with each additional risk factor, but to a lesser extent, and was strongly associated with prior bleeding.
The researchers wrote that high ischemic risk in patients with multiple risk factors underscored an essential need for more preventive treatment.
In a related editorial, Arthur Darmon, an interventional cardiology fellow, and Gregory Ducrocq, MD, PhD, FESC, an interventional cardiologist and director of the coronary care unit at Bichat-Claude Bernard Hospital in Paris, wrote: “The fact that the risk of ischemic events increased when patients had several risk factors is not surprising. However, the relatively small increase in bleeding risk is more unexpected and this differential increase has potential clinical implications.” – by Earl Holland Jr.
Disclosures: Lindholm is an employee of AstraZeneca. The editorial authors report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.