Author + information
- Barbara Stähli1,
- Philipp Jakob2,
- Roland Klingenberg3,
- Slayman Obeid4,
- Dik Heg5,
- Lorenz Raber6,
- Stephan Windecker6,
- Baris Gencer7,
- Ulf Landmesser8,
- Christian Matter9 and
- Willibald Maier10
- 1Charite, Berlin, Germany
- 2Department of Cardiology, Berlin, Germany
- 3Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
- 4universität spital zürich, Zurich, Switzerland
- 5Clinical Trials Unit, Department of Clinical Research, Institute of Social and, Bern, Switzerland
- 6University Hospital Bern, Bern, Switzerland
- 7University Hospital of Geneva, geneva, Switzerland
- 8Department of Cardiology, Charité Berlin – University Medicine, Campus Benjamin Franklin, Berlin, Germany
- 9university hospital of zurich, zurich, Switzerland
- 10Unispital Zurich, Zurich, Switzerland
The age, creatinine, and ejection fraction (ACEF) score (age/left ventricular ejection fraction+1 if creatinine >2.0 mg/dL) has been established for the risk prediction of patients evaluated for coronary artery bypass graft surgery. Data on its predictive value in “all-comers” patients with acute coronary syndromes undergoing percutaneous coronary intervention is lacking.
The ACEF score was calculated for 1901 of the 2168 patients prospectively enrolled in the Swiss Acute Coronary Syndrome Cohort between December 2009 and October 2012. Patients were divided according to ACEF score tertiles (T1 ≤1.057, >1.057 T2 ≤1.389, T3 >1.389). The primary endpoint was all-cause mortality. Major adverse cardiovascular and cerebrovascular events (MACCE) included all-cause death, non-fatal myocardial infarction, repeat coronary revascularization, definite stent thrombosis, and transient ischemic attack/stroke.
One-year mortality increased with ACEF score tertiles (T1: 0.8%, T2: 2.1%, and T3: 10.7%, adjusted HR 3.89, 95% CI 2.50-6.06, p<0.01, Figure 1). Rates of MACCE (adjusted HR 1.75, 95% CI 1.43-2.14, p<0.001), non-fatal myocardial infarction (adjusted HR 1.44, 95% CI 1.01-2.05, p=0.04), and transient ischemic attack/stroke (adjusted HR 4.20, 95% CI 2.03-8.67, p<0.001) were more frequent in patients with higher ACEF scores. The rate of TIMI major bleeding increased with higher ACEF score tertiles (T1: 2.2%, T2: 2.4%, and T3: 5.2%, adjusted HR 1.92, 95% CI 1.32-2.81, p=0.001).
The ACEF score is a simple and useful tool in the risk stratification of patients with acute coronary syndromes referred for coronary angiography, and may help to further improve clinical decision making in patients at increased risk.
CORONARY: Acute Coronary Syndromes