ACEF score adapted to ST-elevation myocardial infarction patients: The ACEF-STEMI score

The age, creatinine and ejection fraction (ACEF) score has originally been developed for risk stratification of patients undergoing elective cardiac surgery. In patients with stable coronary artery disease treated by percutaneous coronary intervention (PCI), the prognostic accuracy of ACEF could be...

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Bibliographic Details
Published in:International journal of cardiology 2018-08, Vol.264, p.18-24
Main Authors: Reindl, Martin, Reinstadler, Sebastian Johannes, Tiller, Christina, Kofler, Markus, Theurl, Markus, Klier, Nora, Fleischmann, Katherina, Mayr, Agnes, Henninger, Benjamin, Klug, Gert, Metzler, Bernhard
Format: Article
Language:English
Subjects:
ACEF score
Austria
Cardiac magnetic resonance imaging
Creatinine - analysis
Female
Humans
Male
Middle Aged
Percutaneous Coronary Intervention - adverse effects
Percutaneous Coronary Intervention - methods
Predictive Value of Tests
Prognosis
Renal Insufficiency - diagnosis
Renal Insufficiency - etiology
Research Design
Risk Assessment - methods
Risk stratification
ST Elevation Myocardial Infarction - diagnosis
ST Elevation Myocardial Infarction - surgery
ST-elevation myocardial infarction
Stroke Volume
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Summary:The age, creatinine and ejection fraction (ACEF) score has originally been developed for risk stratification of patients undergoing elective cardiac surgery. In patients with stable coronary artery disease treated by percutaneous coronary intervention (PCI), the prognostic accuracy of ACEF could be further improved by modifying the original scoring system (called “modified ACEF” or “ACEF-MDRD”). We aimed to specifically adapt the ACEF score for risk assessment of ST-elevation myocardial infarction (STEMI) patients. In this observational study, 390 STEMI patients undergoing primary PCI were included. Clinical endpoint was the occurrence of major adverse cardiovascular events (MACE) comprising all-cause mortality, non-fatal re-infarction, stroke and new congestive heart failure. Original ACEF (area under the curve (AUC):0.63 [95%CI:0.53–0.73]; p = 0.01) and ACEF-MDRD score (AUC:0.62 [95%CI:0.53–0.72]; p = 0.01) significantly but weakly predicted MACE (n = 41, 11%). The addition of creatinine > 2 mg/dl (as suggested in original ACEF, p = 0.32) or eGFR steps as proposed in ACEF-MDRD (p = 0.17) to age/EF ratio were not associated with net reclassification improvements (NRI), but ΔeGRF (>10 ml/min/1.73 m2 decrease within three days after PCI) led to an NRI of 0.29 (95%CI:0.14–0.45; p 
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2018.04.017