Major adverse cardiovascular events

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Major adverse cardiovascular events (MACE, or major adverse cardiac events) is a composite endpoint frequently used in cardiovascular research.[1][2] Despite widespread use of the term in clinical trials, the definitions of MACE can differ, which makes comparison of similar studies difficult.[3]

The so-called "classical 3-point MACE" is defined as a composite of nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death.[4][5] But another study defines MACE as "CVD events, admission for HF (Heart Failure), ischemic cardiovascular [CV] events, cardiac death, or MACE".[6] Yet another study defined MACE as "CV death, hospitalization for HF, or myocardial infarction (MI)".[7]

Two reviews have concluded that SGLT2 inhibitors benefit patients with atherosclerotic MACE.[8][9] One of those studies defined MACE as the composite of myocardial infarction, stroke, or cardiovascular death.[8]

The heterogeneity of the sets defining MACE, hampering systematic reviews and meta-analyses, has been repeatedly criticized.[10][11][12]

References

  1. ^ Bonora BM, Avogaro A, Fadini GP (2020). "Extraglycemic Effects of SGLT2 Inhibitors: A Review of the Evidence". Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 13: 161–174. doi:10.2147/DMSO.S233538. PMC 6982447. PMID 32021362.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  2. ^ Chong WH, Yanoff LB, Andraca-Carrera E, Hai MT (2020). "Assessing the Safety of Glucose-Lowering Drugs - A New Focus for the FDA". The New England Journal of Medicine. 383 (13): 1199–1202. doi:10.1056/NEJMp2004889. PMID 32966719. S2CID 221888300.
  3. ^ Kip KE, Hollabaugh K, Marroquin OC, Williams DO (2008). "The problem with composite end points in cardiovascular studies: the story of major adverse cardiac events and percutaneous coronary intervention". Journal of the American College of Cardiology. 51 (7): 701–707. doi:10.1016/j.jacc.2007.10.034. PMID 18279733.
  4. ^ de Jong M, van der Worp HB, van der Graaf Y, Visseren FL, Westerink J (2017). "Pioglitazone and the secondary prevention of cardiovascular disease. A meta-analysis of randomized-controlled trials". Cardiovascular Diabetology. 16 (1): 134. doi:10.1186/s12933-017-0617-4. PMC 5644073. PMID 29037211.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  5. ^ Arnott C, Li Q, Kang A, Neuen BL, Bompoint S, Lam CS, Rodgers A, Mahaffey KW, Cannon CP, Perkovic V, Jardine MJ, Neal B (2020). "Sodium-Glucose Cotransporter 2 Inhibition for the Prevention of Cardiovascular Events in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis". Journal of the American Heart Association. 9 (3): e014908. doi:10.1161/JAHA.119.014908. PMC 7033896. PMID 31992158.
  6. ^ Heianza Y, Ma W, Manson JE, Rexrode KM, Qi L (2017). "Gut Microbiota Metabolites and Risk of Major Adverse Cardiovascular Disease Events and Death: A Systematic Review and Meta-Analysis of Prospective Studies". Journal of the American Heart Association. 6 (7): e004947. doi:10.1161/JAHA.116.004947. PMC 5586261. PMID 28663251.
  7. ^ Ramchand J, Patel SK, Srivastava PM, Farouque O, Burrell LM (2018). "Elevated plasma angiotensin converting enzyme 2 activity is an independent predictor of major adverse cardiac events in patients with obstructive coronary artery disease". PLOS One. 13 (6): e0198144. Bibcode:2018PLoSO..1398144R. doi:10.1371/journal.pone.0198144. PMC 5999069. PMID 29897923.
  8. ^ a b Zelniker TA, Wiviott SD, abatine MS (2019). "SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials". The Lancet. 393 (10166): 31–39. doi:10.1016/S0140-6736(18)32590-X. PMID 30424892. S2CID 53277899.
  9. ^ Xu D, Chandler O, Xiao H (2021). "Sodium-Glucose Cotransporter-2 Inhibitor (SGLT2i) as a Primary Preventative Agent in the Healthy Individual: A Need of a Future Randomised Clinical Trial?". Frontiers in Medicine. 8: 712671. doi:10.3389/fmed.2021.712671. PMC 8419219. PMID 34497814.
  10. ^ Poudel, I; Tejpal, C; Rashid, H; Jahan, N (30 July 2019). "Major Adverse Cardiovascular Events: An Inevitable Outcome of ST-elevation myocardial infarction? A Literature Review". Cureus. 11 (7): e5280. doi:10.7759/cureus.5280. PMID 31423405. S2CID 201040946.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  11. ^ Bonsu, JM; Guha, A; Charles, L; Yildiz, VO; Wei, L; Baker, B; Brammer, JE; Awan, F; Lustberg, M; Reinbolt, R; Miller, ED; Jneid, H; Ruz, P; Carter, RR; Milks, MW; Paskett, ED; Addison, D (18 February 2020). "Reporting of Cardiovascular Events in Clinical Trials Supporting FDA Approval of Contemporary Cancer Therapies". Journal of the American College of Cardiology. 75 (6): 620–628. doi:10.1016/j.jacc.2019.11.059. PMID 32057377.
  12. ^ Bosco, E; Hsueh, L; McConeghy, KW; Gravenstein, S; Saade, E (6 November 2021). "Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review". BMC Medical Research Methodology. 21 (1): 241. doi:10.1186/s12874-021-01440-5. PMID 34742250. S2CID 243767377.{{cite journal}}: CS1 maint: unflagged free DOI (link)


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