Georgian Medical News · Sep 2026
MAJOR ADVERSE CARDIOVASCULAR EVENTS AFTER ACUTE CORONARY SYNDROME: DEFINITION, TIMING, RATES, MAIN RISK FACTORS, AND WAYS TO IMPROVE
By Gogoberidze D, Bakhutashvili I
AIM OF STUDY: This review summarizes current evidence on MACE definitions, the timing and magnitude of post-ACS risk, its main drivers, and evidence-based risk-reduction strategies, and identifies key methodological gaps. MATERIALS AND METHODS: This narrative synthesis includes randomized controlled trials, meta-analyses, large registries, and observational studies reporting MACE after ACS, identified through PubMed and cross-referenced guideline documents. No systematic search protocol or quantitative synthesis was performed; priority was given to peer-reviewed publications, current guidelines, and high-impact meta-analyses, with sources cited for pooled estimates. RESULTS: MACE definitions are heterogeneous. The classical 3-point composite (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke) is the regulatory standard, but 4- and 5-point versions incorporating revascularization, unstable angina, or heart-failure hospitalization are common, and administrative datasets often substitute all-cause mortality. Broader definitions inflate event rates and can affect interpretation of treatment effects. Data from one of the largest meta-analyses indicate that nearly half of the adverse events during the first year occur within 90 days, with an overall 90-day MACE rate of 4.1%. However, it should be noted that one-year rates range from 3.6% in a small cohort of lower-risk patients to 34.4% in a large national registry, reflecting differences in patient composition, the completeness of revascularization performed, and definitions of MACE components. The strongest predictors of post-ACS MACE were clinical severity (Killip class >II, cardiogenic shock/arrest, LVEF ≤40%), comorbidity burden (chronic kidney disease, diabetes, hypertension, dyslipidemia, smoking, age/frailty), and anatomical/procedural factors (multivessel disease, incomplete revascularization, suboptimal TIMI flow). Complete revascularization, high-intensity statin therapy, individualized dual antiplatelet duration, and structured secondary prevention were each associated with reduced MACE. CONCLUSIONS: Post-ACS MACE clusters within 90 days after discharge. However, reported incidence varies widely due to heterogeneous endpoint definitions and population differences. Standardizing MACE definition and adjudication reporting, and designing trials powered for early endpoints, would meaningfully improve evidence synthesis. Clinicians should prioritize complete revascularization, optimized lipid-lowering, individualized antithrombotic therapy, and early, intensive secondary prevention.