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SCORE 2

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SCORE2 cardiovascular risk

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SCORE2 cardiovascular risk algorithm ESC official

SCORE2 is the European Society of Cardiology model for estimating a person’s 10-year risk of first fatal or nonfatal cardiovascular disease event: myocardial infarction, stroke, or cardiovascular death.
It uses:
  • Age and sex
  • Smoking status
  • Systolic blood pressure
  • Non-HDL cholesterol
  • European risk region
It is designed mainly for apparently healthy adults aged 40-69 years. For older adults, use SCORE2-OP. It is not intended for people who already have established cardiovascular disease, diabetes with high risk, severe chronic kidney disease, or familial hypercholesterolaemia, since these groups are already considered high-risk. The ESC SCORE2 tools provide the official calculator.
To calculate it, send: age, sex, country/region, smoking status, systolic BP, and total plus HDL cholesterol, or non-HDL cholesterol.

MACE

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major adverse cardiovascular events definition

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MACE major adverse cardiovascular events definition endpoints cardiovascular trials

MACE = Major Adverse Cardiovascular Events.
Usually it is a composite outcome of:
  1. Cardiovascular death
  2. Nonfatal myocardial infarction
  3. Nonfatal stroke
This is called 3-point MACE.
Some studies use broader definitions:
  • 4-point MACE: 3-point MACE + unstable angina hospitalization or coronary revascularization
  • 5-point MACE: may additionally include heart-failure hospitalization
Always check the individual study’s endpoint definition because “MACE” is not fully standardized. A systematic review found substantial variation in definitions, especially in observational studies.

MINOCA

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MINOCA diagnosis management

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MINOCA definition diagnostic criteria management scientific statement official

MINOCA = Myocardial Infarction with Non-Obstructive Coronary Arteries.
It is a working diagnosis, not a single disease. The patient meets criteria for acute myocardial infarction, but coronary angiography shows no epicardial coronary stenosis ≥50%.

Diagnostic criteria

  1. Acute MI by the universal definition, including a rise/fall in troponin with clinical evidence of myocardial ischemia
  2. Coronary angiography showing <50% stenosis in all major epicardial vessels
  3. No immediately obvious alternative explanation for the presentation

Important causes

  • Plaque rupture or erosion not visible on standard angiography
  • Coronary vasospasm
  • Coronary microvascular dysfunction
  • Spontaneous coronary artery dissection (SCAD)
  • Coronary embolism or thrombosis
Conditions such as myocarditis and Takotsubo syndrome can initially resemble MINOCA but should be identified and classified separately after further testing.

Evaluation

  • Cardiac MRI: distinguishes infarction from myocarditis and Takotsubo syndrome
  • OCT or IVUS: detects plaque disruption or SCAD missed on angiography
  • Consider coronary vasospasm or microvascular-function testing in selected cases

Treatment

Management is directed at the confirmed mechanism:
  • Atherosclerotic plaque disruption: secondary prevention such as antiplatelet therapy, statin, ACE inhibitor/ARB, and often beta-blocker as appropriate
  • Vasospasm: calcium-channel blocker, nitrates; avoid triggers such as smoking
  • SCAD, embolism, or microvascular dysfunction: tailored specialist management
MINOCA accounts for roughly 6%-10% of acute MIs and is more frequent in women than typical obstructive MI. The ESC overview emphasizes mechanism-based diagnosis and treatment. Recent systematic reviews also support detailed invasive assessment where appropriate, including intracoronary imaging (PMID 39689931).
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