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Objectives This study aimed to evaluate the prevalence of secondary cardiac/ischaemic events (SCIEs) in an Irish acute coronary syndrome (ACS) population and assess associations between standardised modifiable risk factors (SMuRFs), non-standardised modifiable risk factors (Non-SMuRFs) and SCIEs.Methods A retrospective dataset analysis of 82 Irish ACS patients was analysed for SCIE prevalence, including STEMI, NSTEMI, Stable Angina, Unstable Angina, SCAD, and other ischaemic events over one-month to seven-years. Chi-square tests, Mann-Whitney U tests and Independent t-tests were used to assess associations between risk factors and SCIEs. SMuRFs examined included hyperlipidaemia, hypertension, smoking, and Type 2 Diabetes Mellitus (T2DM) and their quantifiable subcategories. Non-SMuRFs such as alcohol consumption, physical inactivity, anxiety, depression, and BMI were also analysed.Results SCIEs occurred in 31.71% of patients, with a mean of 1.27 events among affected patients and 0.40 events per patient overall. Cardiac events accounted for 81.81% of SCIEs. Total cholesterol >5mmol/L was significantly associated with STEMI (p=0.048). Hypertension was linked to Stable Angina (p=0.045) and SCIEs overall (p=0.015), with diastolic BP >90mmHg showing significant associations with SCAD, Stable Angina, and Lower Limb Ischaemia. Smoking and its subcategories (current and ex-smoker) were significantly linked to Unstable Angina, TIA, and Stable Angina. T2DM, including prediabetes (HbA1c >42), was strongly associated with Stable Angina (p<0.001,) as seen in table 1. Non-SMuRFs, such as high BMI and psychological factors, also showed significant links to SCIEs. BMI >25 and >30 was linked to SCIEs (p=0.036) and Stable Angina (p=0.005). Anxiety and/or depression was strongly associated with STEMI (p=0.023) as sewn in table 2.Conclusions SCIE prevalence in this cohort highlights the need for improved ACS management and secondary prevention strategies. SMuRFs, particularly hypertension, smoking, and T2DM, were strongly associated with SCIEs, emphasising the importance of targeted interventions. Non-SMuRFs, including anxiety, depression, and BMI, warrant further research to understand their role in SCIE prevention.Abstract 33 Table 1SMuRFs with significant associations with SCIEsAbstract 33 Table 2Non-SMuRFs with significant associations and near-significant trends with SCIEs