Unmasking the hidden risks of coronary revascularization: Indonesian multicenter insights from INTERASPIRE on determinant factors driving major adverse cardiovascular events in acute coronary syndrome

Background Major Adverse Cardiovascular Events (MACE) remain a critical outcome in patients with Acute Coronary Syndrome (ACS), despite advances in secondary prevention strategies. Identifying determinant factors is essential for optimizing risk stratification. Purpose This study aims to evaluate clinical and determinant factors of one-year MACE among Indonesian ACS patients. Methods This multicenter prospective cohort study (INTERASPIRE Indonesia) involved 170 post-ACS patients from seven centers receiving guideline-based secondary prevention. Participants had experienced ACS within the past 6–24 months. Biomarkers were assessed using thresholds: Galectin-3 ≥ 20.65 ng/mL and Lp(a) ≥ 7.5 mg/dL (Youden index); Troponin I ≥ 10 ng/L, total cholesterol ≥ 200 mg/dL, LDL-C ≥ 55 mg/dL, and HbA1c ≥ 6.5% (guideline-based). Additional variables included demographics, SBP, BMI, and pharmacotherapy. The primary endpoint was first MACE occurrence within 12 months. Multivariable logistic regression assessed associations, reporting p-values, , hazard ratios (HR), relative risks (RR), and 95% confidence intervals (CI). Model calibration was evaluated using the Hosmer-Lemeshow test and Nagelkerke R2. Results Among 170 patients, 25 (14.7%) experienced MACE during follow-up. Elevated Galectin-3 (p: 0.037; HR 3.22; 95% CI: 1.07–9.63; RR: 2.1, 95% CI: 0.89–5.05) and Troponin-I (p: 0.040; HR: 3.14; 95% CI: 1.06–9.34; RR: 2.02; 95% CI: 0.86–4.77) were significant predictors of MACE. Use of double antiplatelet was associated with lower risk (p: 0.010; HR: 0.19; 95% CI: 0.06–0.57; RR: 3.25, 95% CI: 1.16-9.13) and calcium channel blockers (CCBs) (p: 0.006, HR: 0.17; 95% CI: 0.05-0.61; RR: 2.84; 95% CI: 1.12-7.16). LDL-Cholesterol, Lipoprotein(a), HbA1c, SBP, BMI and other medications were not significantly associated. The model showed acceptable calibration (Hosmer–Lemeshow p: 0.559) with moderate explanatory power (Nagelkerke R²: 0.294). Conclusion Elevated Galectin-3 and Troponin-I were identified as independent predictors that increase MACE risk among Indonesian ACS patients, while dual antiplatelet therapy and calcium channel blocker use were associated with reduced risk. These findings underscore the value of biomarker-guided monitoring and personalized therapeutic strategies to enhance secondary prevention and improve post-ACS outcomes.