{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T13:44:36Z","timestamp":1776519876105,"version":"3.51.2"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec id=\"jah311052-sec-0001\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Patients with acute coronary syndrome (ACS) are at high risk for recurrent cardiovascular events and bleeding complications, particularly in Asian populations. The long\u2010term impact of multiple cardiovascular events and bleeding on outcomes remains unclear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah311052-sec-0002\" xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">Using Taiwan's National Health Insurance Research Database, this retrospective cohort study included 28\u2009086 patients with ACS categorized into single\u2010event and multiple\u2010event groups based on cardiovascular events occurring within 2\u2009years of the index ACS event. After matching for age, sex, and event interval, 8756 patients were assigned to the multiple\u2010event group and 17\u2009446 to the single\u2010event group.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah311052-sec-0003\" xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The multiple\u2010event group had higher comorbidity rates, including hypertension, prior coronary disease, heart failure, stroke, and chronic kidney disease. Over 5\u2009years, the multiple\u2010event group had significantly higher all\u2010cause mortality (34.0% versus 24.0%) and cardiovascular mortality (11.2% versus 5.5%) compared with the single\u2010event group (both\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.0001). Major (8.4% versus 1.6%) and minor (35.5% versus 7.4%) bleeding rates were also higher (both\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.0001). Notably, major bleeding persisted beyond 3 months in the multiple\u2010event group, whereas the single\u2010event group showed reduced bleeding after 1 month. In the multiple\u2010event group, each additional major bleeding event was associated with earlier subsequent cardiovascular events (coefficient=\u22120.2875,\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.0325).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah311052-sec-0004\" xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Patients with ACS with multiple cardiovascular events have higher rates of all\u2010cause mortality, cardiovascular mortality, and major bleeding than patients with ACS with a single cardiovascular event. Major bleeding may also be associated with the risk of subsequent cardiovascular events, highlighting the importance of implementing a tailored antiplatelet strategy in Asian populations.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.039290","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T05:50:07Z","timestamp":1750225807000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Multiple Cardiovascular Events on Long\u2010Term Outcomes and Bleeding Risk in Patients With Acute Coronary Syndrome: A\u00a0Nationwide Population\u2010Based Cohort Study"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1249-5699","authenticated-orcid":false,"given":"Chih\u2010Wei","family":"Chen","sequence":"first","affiliation":[{"name":"Taipei Medical University Hospital","place":["Taipei, Taiwan"]},{"name":"Taipei Medical University","place":["Taipei, Taiwan"]},{"name":"Taipei Medical University","place":["Taipei, Taiwan"]},{"name":"Taipei Medical University","place":["Taipei, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3599-7758","authenticated-orcid":false,"given":"Yi\u2010Cheng","family":"Lin","sequence":"additional","affiliation":[{"name":"Taipei Medical University Hospital","place":["Taipei, Taiwan"]},{"name":"Taipei Medical University","place":["Taipei, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5799-6513","authenticated-orcid":false,"given":"Donna Shu\u2010Han","family":"Lin","sequence":"additional","affiliation":[{"name":"Shin Kong Wu Ho\u2010Su Memorial Hospital","place":["Taipei, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chia\u2010Li","family":"Chang","sequence":"additional","affiliation":[{"name":"Taipei Medical University","place":["Taipei, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8978-7879","authenticated-orcid":false,"given":"Chun\u2010Yao","family":"Huang","sequence":"additional","affiliation":[{"name":"Taipei Medical University Hospital","place":["Taipei, Taiwan"]},{"name":"Taipei Medical University","place":["Taipei, Taiwan"]},{"name":"Taipei Medical University","place":["Taipei, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaw\u2010Wen","family":"Chen","sequence":"additional","affiliation":[{"name":"Taipei Medical University Hospital","place":["Taipei, Taiwan"]},{"name":"Taipei Medical University","place":["Taipei, Taiwan"]},{"name":"Taipei Medical University","place":["Taipei, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shing\u2010Jong","family":"Lin","sequence":"additional","affiliation":[{"name":"Taipei Medical University Hospital","place":["Taipei, Taiwan"]},{"name":"Taipei Medical 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