MACE (major adverse cardiovascular events) is a composite endpoint used in clinical trials to assess, with a single metric, how a treatment affects the most severe outcomes.
Instead of counting heart attack, stroke and death separately, they are combined into one "basket": an event counts if at least one of them occurs.
What MACE includes
The classic "3-point" MACE comprises cardiovascular death, non-fatal myocardial infarction and non-fatal stroke. The "4-point" version adds a fourth outcome — most often hospitalization for unstable angina or heart failure, less often coronary revascularization.
There is no single standard: each trial defines its own MACE composition, so numbers from different studies are not directly comparable.
Why a composite endpoint is needed
Severe events individually are rare, and proving a treatment effect would require huge samples. Combining outcomes increases statistical power and makes it possible to see the total benefit or harm of a therapy within a reasonable time.
The downside is heterogeneity: a reduction in a "soft" component (hospitalizations) can mask the absence of an effect on mortality. That is why the individual components are examined alongside MACE.
MACE and prevention
It is precisely through the reduction of MACE that the benefit of statins, blood-pressure control and antithrombotic therapy has been proven. For an individual person the analog of MACE is their personal 10-year ASCVD risk: it estimates the probability of the same events and helps choose the intensity of prevention.
Calculate using this marker
Calculators where MACE is used directly:
Frequently asked questions
How does MACE differ from ASCVD risk?
MACE is an outcome in a trial (the event either happened or not), whereas ASCVD is a forecast of the probability of such an event in a specific person over 10 years. In essence ASCVD predicts an individual's chance of joining the MACE statistics.
Is revascularization included in MACE?
Sometimes. In broader definitions, elective or emergency revascularization or hospitalization is added to death, heart attack and stroke. You always need to check how MACE is defined in the particular study.