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

• Published in: International journal of cardiology Vol. 270; pp. 7 - 13
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.11.2018
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - blood; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - surgery; Age Factors; Aged; Aged, 80 and over; Cohort Studies; Creatinine - blood; Female; Humans; Male; Middle Aged; Mortality - trends; Percutaneous coronary intervention; Percutaneous Coronary Intervention - trends; Predictive Value of Tests; Prospective Studies; Risk prediction; Stroke Volume - physiology; Acute coronary syndrome; Risk prediction; Percutaneous coronary intervention
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2018.05.134

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. 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. 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). The ACEF score is a simple and useful risk stratification tool in patients with ACS referred for coronary revascularization. •The ACEF score independently predicted outcomes in ACS patients referred for coronary revascularization.•Based on the ACEF score, three different risk groups could be identified.•The ACEF score yielded similar predictive value as the GRACE score.•This score may provide a novel and simple tool to stratify the risk of ACS patients for everyday clinical practice.