Average daily ischemic and bleeding risk following acute coronary syndrome: Insights from the FORCE-ACS registry

AIMS: To characterize ischemic and bleeding events and compare the average daily ischemic rate (ADIR) and average daily bleeding rate (ADBR) during three years post-ACS. METHODS AND RESULTS: Data were derived from ACS patients enrolled in the prospective multicenter FORCE-ACS registry in nine Dutch hospitals between 2015 and 2019. ADIR and ADBR, expressed as events per 100 person-days, were calculated by dividing the total number of events by total follow-up time in the acute (day 0 to 1), subacute (day 1 to 30), late (day 30 to 365) and very late (day 365 to 1095) phase. Ischemic events comprised cardiovascular death, myocardial infarction and definite stent thrombosis; bleeding events comprised Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding. The Wilcoxon signed rank test compared the ADIR and ADBR per phase.During three years, 929 ischemic events occurred in 808 patients (16.1%) and 1,694 bleeding events in 1,177 patients (23.4%). The ADBR was higher than ADIR in the acute (1.41 vs 0.68) and late phase (0.04 vs 0.02). No significant difference was observed in the subacute (0.23 vs 0.13) and very late phase. Overall, the ADBR exceeded the ADIR (0.03 vs 0.02), with the highest difference during the first year. CONCLUSIONS: Ischemic and bleeding events are most prevalent in the first 30 days post-ACS. Both ADIR and ADBR decrease over time, with the excess of ADBR over ADIR being most pronounced during the first year of follow-up.