Cardiovascular

Major cardiovascular events in Japanese patients with acute and chronic coronary syndrome.

TL;DR

Recurrent cardiovascular risk was highest after a first ACS event and was heterogeneous in CCS, with substantially higher risk in comorbidity-burdened subgroups, providing contemporary real-world estimates to support refinement of risk-stratification approaches for secondary prevention.

Key Findings

The 1-year risk of the primary composite endpoint (all-cause death, myocardial infarction, or stroke) was highest in first-time ACS patients at 17.7%, compared to 8.0% in prior ACS and 5.3% in CCS patients.

  • 26,656 patients were included in the ACS cohort and 16,172 in the CCS cohort
  • Median follow-up was 3.0 years in the ACS cohort and 3.2 years in the CCS cohort
  • The primary composite endpoint included all-cause death, myocardial infarction, or stroke
  • Data were drawn from the Medical Data Vision claims database, a retrospective cohort study design

The 5-year risk of the primary composite endpoint was 24.0% in first-time ACS, 13.8% in prior ACS, and 12.0% in CCS patients.

  • First-time ACS patients had nearly double the 5-year risk compared to CCS patients (24.0% vs 12.0%)
  • Prior ACS patients had intermediate 5-year risk at 13.8%
  • Time-to-event analyses were conducted to estimate these risks
  • These estimates represent contemporary real-world data from Japanese patients

In CCS patients, a high-risk subgroup comprising elderly men with prior ACS, heart failure, diabetes mellitus, and chronic kidney disease had a 23.0% 1-year risk of the primary endpoint.

  • This 1-year risk of 23.0% in the high-risk CCS subgroup exceeded even the first-time ACS cohort's 1-year risk of 17.7%
  • The high-risk subgroup was defined by the combination of elderly age, male sex, prior ACS, heart failure, diabetes mellitus, and chronic kidney disease
  • Baseline clinical characteristics were evaluated as predictors of outcomes
  • Findings demonstrate that CV risk in CCS is heterogeneous depending on comorbidity burden

Recurrent cardiovascular risk was highest after a first ACS event and was heterogeneous across CCS subgroups.

  • The study used a retrospective cohort design with data from the Medical Data Vision claims database in Japan
  • Patients were followed from cohort entry to the first composite CV endpoint or end of data
  • A secondary composite endpoint also included hospitalisation for unstable angina, hospitalisation for heart failure, and emergent or elective coronary revascularisation
  • The findings support further refinement and validation of risk-stratification approaches for secondary prevention

Cardiovascular disease remains the second leading cause of mortality in Japan, yet real-world estimates of recurrent CV risk across ACS and CCS phenotypes have been limited.

  • The study was motivated by a gap in real-world evidence for recurrent CV risk across different coronary syndrome phenotypes in Japan
  • The study aimed to quantify recurrent CV risk and characterise high-risk subgroups in Japanese patients
  • The Medical Data Vision claims database was used as the real-world data source
  • The study distinguished between first-time ACS, prior ACS, and CCS as separate phenotypic groups

What This Means

This research examined how likely Japanese patients with different types of heart disease are to have another serious cardiovascular event—such as a heart attack, stroke, or death—after their initial diagnosis. The study looked at over 42,000 patients, dividing them into groups based on whether they had an acute coronary syndrome (ACS, meaning a sudden blockage like a heart attack) for the first time, had a prior ACS, or had chronic coronary syndrome (CCS, meaning stable, long-term heart disease). Using a large Japanese hospital claims database, researchers tracked these patients for roughly three years on average. The study found that patients experiencing their first ACS had the highest short-term risk, with nearly 1 in 5 (17.7%) suffering a major cardiovascular event within just one year, rising to nearly 1 in 4 (24.0%) within five years. Patients with stable chronic coronary syndrome had lower overall risk (5.3% at one year), but this varied enormously depending on individual health factors. Elderly men with CCS who also had prior heart attacks, heart failure, diabetes, and kidney disease faced a 23% risk within one year—actually higher than the average first-time ACS patient. This research suggests that not all heart disease patients face the same level of ongoing risk, and that identifying high-risk subgroups—particularly those with multiple conditions like diabetes, kidney disease, and heart failure—is critical for guiding preventive treatment decisions. The findings provide updated, real-world data from Japan to help clinicians better target secondary prevention strategies to the patients who need them most.

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Citation

Osada N, Sheng F, Chang C, Clouser M, Tanaka S, Ludwikowska M, et al.. (2026). Major cardiovascular events in Japanese patients with acute and chronic coronary syndrome.. Open heart. https://doi.org/10.1136/openhrt-2026-004247