Predictive value of the age, creatinine, and ejection fraction (ACEF) score in patients with acute coronary syndromes.

Stähli, Barbara E; Wischnewsky, Manfred B; Jakob, Philipp; Klingenberg, Roland; Obeid, Slayman; Heg, Dik; Räber, Lorenz; Windecker, Stephan; Roffi, Marco; Mach, François; Gencer, Baris; Nanchen, David; Jüni, Peter; Landmesser, Ulf; Matter, Christian M; Lüscher, Thomas F; Maier, Willibald (2018). Predictive value of the age, creatinine, and ejection fraction (ACEF) score in patients with acute coronary syndromes. International journal of cardiology, 270, pp. 7-13. Elsevier 10.1016/j.ijcard.2018.05.134

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BACKGROUND

This study sought to investigate the predictive value of the age, creatinine, and ejection fraction (ACEF) score in patients with acute coronary syndromes (ACS). The ACEF score (age/left ventricular ejection fraction +1 [if creatinine > 176 μmol/L]) has been established in patients evaluated for coronary artery bypass surgery. Data on its predictive value in all-comer ACS patients undergoing percutaneous coronary intervention are scarce.

METHODS

A total of 1901 patients prospectively enrolled in the Swiss ACS Cohort were included in the analysis. Optimal ACEF score cut-off values were calculated by decision tree analysis, and patients divided into low-risk (≤1.45), intermediate-risk (>1.45 and ≤2.0), and high-risk groups (>2.0). The primary endpoint was all-cause mortality. Major adverse cardiac and cerebrovascular events (MACCE) included all-cause death, non-fatal myocardial infarction, clinically indicated repeat coronary revascularization, definite stent thrombosis, and transient ischemic attack/stroke.

RESULTS

One-year rates of all-cause death increased across ACEF score groups (1.6% versus 5.6% versus 23.0%, p < 0.001). In multivariate analysis, the ACEF score was related with an increased risk of all-cause mortality (adjusted HR 3.53, 95% CI 2.90-4.31, p < 0.001), MACCE (adjusted HR 2.23, 95% CI 1.88-2.65, p < 0.001), and transient ischemic attack/stroke (adjusted HR 2.58, 95% CI 1.71-3.89, p < 0.001) at 1 year. Rates of Thrombolysis in Myocardial Infarction (TIMI) major and Global use of Strategies to Open Occluded Coronary Arteries (GUSTO) severe bleeding paralleled the increased ischemic risk across the groups (p < 0.001).

CONCLUSIONS

The ACEF score is a simple and useful risk stratification tool in patients with ACS referred for coronary revascularization.

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