Types and Rates of Major Adverse Cardiovascular Events in Antithrombotic Trials: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
BACKGROUND: Major adverse cardiovascular events (MACE) are common composite end points in trials of antithrombotic therapies, yet their definitions and component event rates may vary between cardiovascular disease and stroke populations. We compared definitions and annualized rates of MACE components, bleeding outcomes, and participant demographics in large randomised trials of antithrombotic strategies for secondary prevention in stroke and cardiovascular disease populations, and primary prevention in at-risk individuals. METHODS: We searched Medline (Ovid) for phase III randomised controlled trials of antithrombotic therapies from 2010 to 2024. Eligible studies had ≥ 500 adults and examined antithrombotic interventions for secondary cardio- or cerebrovascular prevention, or primary prevention in at-risk populations, reported ≥ 1 MACE component (stroke, myocardial infarction [MI], mortality), and had ≥ 90 days of follow-up. RESULTS: Of 2075 studies screened, 57 met inclusion criteria (37 cardiovascular and 17 stroke secondary prevention trials, 3 primary prevention trials; 403,957 participants). Stroke rates were higher in stroke than in cardiovascular trials (7.4%/y vs 1.2%/y; P = 0.004), and MI rates were higher in cardiovascular trials (1.5%/y vs 0.1%/y; P < 0.001). Major bleeding and mortality rates were similar across trial types. In meta-regression, annualised stroke and mortality event rates increased with proportion of female participants and decreased with trial follow-up duration. Definitions of MACE and bleeding were variable. CONCLUSIONS: Differences in recurrent event types between stroke and cardiovascular trials suggest that prevention strategies should be disease-specific. Use of standardised MACE and bleeding definitions may improve between-trial comparisons and generalisability to clinical practice. (Major Adverse Cardiovascular Event Types and Rates in Trials of Secondary Stroke Versus General Cardiovascular Prevention Trials. REGISTRATION: PROSPERO CRD42024566128.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.032 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.019 | 0.044 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".