Ischaemic heart disease

Recurrent ischaemic events outweigh bleeding risk in most post-ACS patients 

Most patients who survive an acute coronary syndrome event are at more risk of an ischaemic rather than a bleeding event, regardless of their ischaemic risk profile, an Australian study shows. 

However, in some patients who have been surgically revascularised the risk of bleeding is higher than a recurrent ischaemic event.

The trial led by Prof. David Brieger from the Concord Hospital in Sydney, used data from the CONCORDANCE registry to develop a predictive model to help clinicians simultaneously balance ischaemic against bleeding risk. 

“Our goal is to better guide decisions regarding antithrombotic (e.g. DAPT) treatment in individual patients surviving 6 months following an ACS,” they wrote in their paper published in Heart, Lung and Circulation. 

Of  5,905 post ACS patients 215 patients (3.64%) had an ischaemic event (CV death [n=42], MI [n=155] or stroke [n=36]) and 49 (0.83%) had a bleeding event requiring hospitalisation.

The research team used a multivariable modelling technique which used common variables – modified TIGRIS1 ischaemic score, mode of revascularisation, history of heart failure, anaemia, multivessel disease, readmission within six months of index ACS and age –  to predict recurrent ischaemic and bleeding events in individual patients.  

Source: Heart, Lung and Circulation

They found that in patients either treated with PCI or not revascularised, ongoing ischaemic risk outweighed bleeding risk during the 6-18 month follow-up period, suggesting ongoing antithrombotic therapy be prioritised. 

In contrast, in patients with comorbidities revascularised with CABG, the risk of bleeding outweighed recurrent ischaemic events. 

“Attention to modifiable bleeding risk factors including requirement for ongoing DAPT should be taken into consideration during ongoing evaluation of these patients,” the authors advised

“We believe this work, once validated in other cohorts, represents an important step in the development of a tool to guide personalised decision making with anti-thrombotics following an ACS,” they concluded.

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