To analyze the risk factors for major adverse cardiovascular and cerebrovascular events in patients with a history of hemorrhagic stroke who undergo percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), providing a basis for improving their prognosis.

Data for this study were obtained from the Tianjin Health Medical Big Data Super Platform, retrospectively selecting patients admitted to 72 secondary and tertiary hospitals in Tianjin City from January 2010 to June 2023 who underwent PCI. Among them, 2015 patients with a history of hemorrhagic stroke were included as the study group; 218 504 patients without such history were included as the control group, and the study population was followed up. The primary endpoint was hemorrhagic stroke; secondary endpoints included all-cause death, acute myocardial infarction, and ischemic stroke. After dividing the study population, the incidence rates of all endpoint events during the first month, third month, sixth month, within one year, within two years, and throughout the follow-up period were compared between the two groups. Multivariate Cox regression was used to evaluate the hazard ratio (HR) and 95% confidence interval (95%CI) of outcome events between the two groups.

The baseline characteristics of the two patient groups, including past medical history, showed significant differences Analysis of adverse events in the two groups revealed that compared to the control group, the study group had significantly higher incidence rates not only for the primary endpoint of hemorrhagic stroke (4.22% vs 0.76%, χ²=304.48, P<0.001) but also for the secondary endpoints of all-cause death (10.20% vs 6.59%, χ²=40.81, P<0.001), ischemic stroke (58.60% vs 15.30%, χ²=2824.19, P<0.001), and acute myocardial infarction (6.80% vs 5.38%, χ²=200.80, P=0.006). Multivariate Cox regression analysis identified several clinical histories and characteristics that could predict the occurrence of hemorrhagic stroke after PCI, including previous hemorrhagic stroke (HR=6.092, 95%CI: 4.875-7.612, P<0.001), age (HR=1.018, 95%CI: 1.013-1.023, P<0.001), male gender (HR=1.229, 95%CI: 1.127-1.381, P<0.001), hypertension (HR=1.223, 95%CI: 1.111-1.369, P<0.001), atrial fibrillation (HR=1.132, 95%CI: 1.023-1.252, P<0.001), and chronic renal insufficiency (HR=1.535, 95%CI: 1.292-1.824, P<0.001).

ACS patients with a history of hemorrhagic stroke have a high risk of major adverse cardiovascular and cerebrovascular events after PCI, with male gender, age, hypertension, atrial fibrillation, and chronic kidney disease being independent risk factors for the recurrence of hemorrhagic stroke post-PCI.