{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T08:28:04Z","timestamp":1786350484156,"version":"build-2736575974"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100020948","name":"AstraZeneca M\u00f6lndal","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020948","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007051","name":"Uppsala University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007051","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Res Cardiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2009\u2265\u200965\u00a0years, chronic kidney disease, diabetes, multivessel disease (MVD), prior bleeding, and prior acute\u00a0myocardial infarction (AMI)) were assessed in relation to the risk of ischaemic (cardiovascular death\/AMI\/stroke) and major bleeding events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We studied 24,051 patients, of whom 59% had\u2009\u2265\u20092\u2009risk factors. During a median follow-up of 3.7 years,\u00a03604 (15.0%) patients experienced ischaemic events and 2076 (8.6%) experienced\u00a0major bleeding\u00a0events . 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.\u00a0 \u00a0  .<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-026-02995-3","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T07:32:54Z","timestamp":1786347174000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic value of risk factors for ischaemic and major bleeding events in chronic coronary syndrome: a SWEDEHEART registry study"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7767-3073","authenticated-orcid":false,"given":"Sergio","family":"Buccheri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5582-8281","authenticated-orcid":false,"given":"Giovanna","family":"Sarno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9088-4035","authenticated-orcid":false,"given":"Lars P\u00e5l","family":"Hasvold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2141-6086","authenticated-orcid":false,"given":"Henrik","family":"Renlund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4413-9736","authenticated-orcid":false,"given":"Stefan","family":"James","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6534-2613","authenticated-orcid":false,"given":"Kasper","family":"Andersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"issue":"36","key":"2995_CR1","doi-asserted-by":"publisher","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","volume":"45","author":"C Vrints","year":"2024","unstructured":"Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J et al (2024) 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J 45(36):3415\u20133537. https:\/\/doi.org\/10.1093\/eurheartj\/ehae177","journal-title":"Eur Heart J"},{"issue":"15","key":"2995_CR2","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1136\/heartjnl-2018-314590","volume":"105","author":"D Lindholm","year":"2019","unstructured":"Lindholm D, Sarno G, Erlinge D, Svennblad B, Hasvold LP, Janzon M et al (2019) Combined association of key risk factors on ischaemic outcomes and bleeding in patients with myocardial infarction. Heart 105(15):1175\u20131181. https:\/\/doi.org\/10.1136\/heartjnl-2018-314590","journal-title":"Heart"},{"issue":"20","key":"2995_CR3","doi-asserted-by":"publisher","first-page":"1617","DOI":"10.1136\/hrt.2010.198804","volume":"96","author":"T Jernberg","year":"2010","unstructured":"Jernberg T, Attebring MF, Hambraeus K, Ivert T, James S, Jeppsson A et al (2010) The Swedish web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies (SWEDEHEART). Heart 96(20):1617\u20131621. https:\/\/doi.org\/10.1136\/hrt.2010.198804","journal-title":"Heart"},{"issue":"1","key":"2995_CR4","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1067\/mhj.2001.116072","volume":"142","author":"V Dzavik","year":"2001","unstructured":"Dzavik V, Ghali WA, Norris C, Mitchell LB, Koshal A, Saunders LD et al (2001) Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: a report from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) investigators. Am Heart J 142(1):119\u2013126. https:\/\/doi.org\/10.1067\/mhj.2001.116072","journal-title":"Am Heart J"},{"issue":"13","key":"2995_CR5","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1056\/NEJMoa041031","volume":"351","author":"AS Go","year":"2004","unstructured":"Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351(13):1296\u20131305. https:\/\/doi.org\/10.1056\/NEJMoa041031","journal-title":"N Engl J Med"},{"issue":"3","key":"2995_CR6","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1161\/01.Hyp.0000177474.06749.98","volume":"46","author":"SS Najjar","year":"2005","unstructured":"Najjar SS, Scuteri A, Lakatta EG (2005) Arterial aging: is it an immutable cardiovascular risk factor? Hypertension 46(3):454\u2013462. https:\/\/doi.org\/10.1161\/01.Hyp.0000177474.06749.98","journal-title":"Hypertension"},{"issue":"15","key":"2995_CR7","doi-asserted-by":"publisher","first-page":"1407","DOI":"10.1056\/NEJMoa1608664","volume":"376","author":"A Rawshani","year":"2017","unstructured":"Rawshani A, Rawshani A, Franz\u00e9n S, Eliasson B, Svensson AM, Miftaraj M et al (2017) Mortality and cardiovascular disease in type 1 and type 2 diabetes. N Engl J Med 376(15):1407\u20131418. https:\/\/doi.org\/10.1056\/NEJMoa1608664","journal-title":"N Engl J Med"},{"issue":"19","key":"2995_CR8","doi-asserted-by":"publisher","first-page":"1791","DOI":"10.1056\/NEJMoa1500857","volume":"372","author":"MP Bonaca","year":"2015","unstructured":"Bonaca MP, Bhatt DL, Cohen M, Steg PG, Storey RF, Jensen EC et al (2015) Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 372(19):1791\u20131800. https:\/\/doi.org\/10.1056\/NEJMoa1500857","journal-title":"N Engl J Med"},{"issue":"14","key":"2995_CR9","doi-asserted-by":"publisher","first-page":"1319","DOI":"10.1056\/NEJMoa1709118","volume":"377","author":"JW Eikelboom","year":"2017","unstructured":"Eikelboom JW, Connolly SJ, Bosch J, Dagenais GR, Hart RG, Shestakovska O et al (2017) Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med 377(14):1319\u20131330. https:\/\/doi.org\/10.1056\/NEJMoa1709118","journal-title":"N Engl J Med"},{"issue":"6","key":"2995_CR10","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1160\/th16-05-0400","volume":"116","author":"L Friberg","year":"2016","unstructured":"Friberg L, Skeppholm M (2016) Usefulness of health registers for detection of bleeding events in outcome studies. Thromb Haemost 116(6):1131\u20131139. https:\/\/doi.org\/10.1160\/th16-05-0400","journal-title":"Thromb Haemost"},{"issue":"7536","key":"2995_CR11","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1136\/bmj.38695.605440.AE","volume":"332","author":"CA Daly","year":"2006","unstructured":"Daly CA, De Stavola B, Sendon JL, Tavazzi L, Boersma E, Clemens F et al (2006) Predicting prognosis in stable angina - results from the Euro heart survey of stable angina: prospective observational study. BMJ 332(7536):262\u20137. https:\/\/doi.org\/10.1136\/bmj.38695.605440.AE","journal-title":"BMJ"},{"issue":"7","key":"2995_CR12","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1016\/j.jacc.2018.11.048","volume":"73","author":"F Costa","year":"2019","unstructured":"Costa F, Van Klaveren D, Feres F, James S, R\u00e4ber L, Pilgrim T et al (2019) Dual antiplatelet therapy duration based on ischemic and bleeding risks after coronary stenting. J Am Coll Cardiol 73(7):741\u201354. https:\/\/doi.org\/10.1016\/j.jacc.2018.11.048","journal-title":"J Am Coll Cardiol"},{"key":"2995_CR13","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.118.008708","author":"M Natsuaki","year":"2018","unstructured":"Natsuaki M, Morimoto T, Yamaji K, Watanabe H, Yoshikawa Y, Shiomi H et al (2018) Prediction of thrombotic and bleeding events after percutaneous coronary intervention: CREDO-Kyoto thrombotic and bleeding risk scores. J Am Heart Assoc. https:\/\/doi.org\/10.1161\/jaha.118.008708","journal-title":"J Am Heart Assoc"},{"issue":"10035","key":"2995_CR14","doi-asserted-by":"publisher","first-page":"2302","DOI":"10.1016\/s0140-6736(16)00741-8","volume":"387","author":"Z Hijazi","year":"2016","unstructured":"Hijazi Z, Oldgren J, Lindb\u00e4ck J, Alexander JH, Connolly SJ, Eikelboom JW et al (2016) The novel biomarker-based ABC (age, biomarkers, clinical history)-bleeding risk score for patients with atrial fibrillation: a derivation and validation study. Lancet 387(10035):2302\u20132311. https:\/\/doi.org\/10.1016\/s0140-6736(16)00741-8","journal-title":"Lancet"},{"issue":"3","key":"2995_CR15","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1161\/circulationaha.119.040167","volume":"140","author":"P Urban","year":"2019","unstructured":"Urban P, Mehran R, Colleran R, Angiolillo DJ, Byrne RA, Capodanno D et al (2019) Defining high bleeding risk in patients undergoing percutaneous coronary intervention. Circulation 140(3):240\u2013261. https:\/\/doi.org\/10.1161\/circulationaha.119.040167","journal-title":"Circulation"},{"issue":"2","key":"2995_CR16","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1046\/j.1525-139x.2003.16025.x","volume":"16","author":"A Levin","year":"2003","unstructured":"Levin A (2003) Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis. Semin Dial 16(2):101\u2013105. https:\/\/doi.org\/10.1046\/j.1525-139x.2003.16025.x","journal-title":"Semin Dial"},{"issue":"10073","key":"2995_CR17","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1016\/s0140-6736(17)30397-5","volume":"389","author":"F Costa","year":"2017","unstructured":"Costa F, van Klaveren D, James S, Heg D, R\u00e4ber L, Feres F et al (2017) Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet 389(10073):1025\u201334. https:\/\/doi.org\/10.1016\/s0140-6736(17)30397-5","journal-title":"Lancet"},{"issue":"14","key":"2995_CR18","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1161\/circulationaha.108.828541","volume":"119","author":"S Subherwal","year":"2009","unstructured":"Subherwal S, Bach RG, Chen AY, Gage BF, Rao SV, Newby LK et al (2009) Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC\/AHA Guidelines) bleeding score. Circulation 119(14):1873\u20131882. https:\/\/doi.org\/10.1161\/circulationaha.108.828541","journal-title":"Circulation"},{"issue":"16","key":"2995_CR19","doi-asserted-by":"publisher","first-page":"1735","DOI":"10.1001\/jama.2016.3775","volume":"315","author":"RW Yeh","year":"2016","unstructured":"Yeh RW, Secemsky EA, Kereiakes DJ, Normand SL, Gershlick AH, Cohen DJ et al (2016) Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA 315(16):1735\u20131749. https:\/\/doi.org\/10.1001\/jama.2016.3775","journal-title":"JAMA"},{"issue":"17","key":"2995_CR20","doi-asserted-by":"publisher","first-page":"1851","DOI":"10.1016\/j.jacc.2016.07.760","volume":"68","author":"G Giustino","year":"2016","unstructured":"Giustino G, Chieffo A, Palmerini T, Valgimigli M, Feres F, Abizaid A et al (2016) Efficacy and safety of dual antiplatelet therapy after complex PCI. J Am Coll Cardiol 68(17):1851\u20131864. https:\/\/doi.org\/10.1016\/j.jacc.2016.07.760","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"2995_CR21","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1093\/eurheartj\/ehx419","volume":"39","author":"M Valgimigli","year":"2018","unstructured":"Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A et al (2018) 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 39(3):213\u2013260. https:\/\/doi.org\/10.1093\/eurheartj\/ehx419","journal-title":"Eur Heart J"}],"container-title":["Clinical Research in Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00392-026-02995-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00392-026-02995-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00392-026-02995-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T07:32:55Z","timestamp":1786347175000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00392-026-02995-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":21,"alternative-id":["2995"],"URL":"https:\/\/doi.org\/10.1007\/s00392-026-02995-3","relation":{},"ISSN":["1861-0684","1861-0692"],"issn-type":[{"value":"1861-0684","type":"print"},{"value":"1861-0692","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]},"assertion":[{"value":"22 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Stefan\u00a0James reports institutional research grants from AstraZeneca, Janssen, Amgen, Novo Nordisk, Novartis. Lars Pa\u030al Hasvold reports being employed by AstraZeneca. The other authors have no relevant conflicts of interest to disclose.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}