A novel risk model combining clinical and intravascular ultrasound-based calcific features to predict adverse outcomes in patients with severe coronary artery calcification undergoing percutaneous coronary intervention: the mACEF- Ca model

Figures

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  Fig. 1. Study flowchart. COPD, chronic obstructive pulmonary disease; SCAD, spontaneous coronary artery dissection; CABG, coronary artery bypass grafting; PCI, percutaneous coronary intervention; MACE, major adverse cardiovascular events; CAC, coronary artery calcification; IVUS, intravascular ultrasound; LVEF, left ventricular ejection fraction

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  Fig. 2. Comparative Overview of Six ACEF-Based Risk Scoring Models Used in Patients with Severe Coronary Artery Calcification. ACEF, Age, Creatinine, and Ejection Fraction; mACEF, Modified Age, Creatinine, and Ejection Fraction; ACEF-MDRD, ACEF score using estimated glomerular filtration rate (eGFR) based on the Modification of Diet in Renal Disease formula; ACEF II, ACEF score incorporating anemia and procedural urgency; ACEF-STEMI, ACEF score adapted for ST-elevation myocardial infarction; ACEF–residual SS = ACEF score incorporating the residual SYNTAX Score; LVEF, Left ventricular ejection fraction; eGFR, Estimated glomerular filtration rate; MDRD, Modification of Diet in Renal Disease; Hb, Hemoglobin; LAD, Left anterior descending coronary artery; CRP, C-reactive protein; DM, Diabetes mellitus

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  Fig. 3. ROC Curve Comparison of Conventional and Novel Risk Scoring Models for Predicting 2-Year Major Adverse Cardiovascular Events. A ROC curves comparing the predictive performance of conventional ACEF-based scoring models, including ACEF, mACEF, ACEF-MDRD, ACEF II, ACEF-rSS, and ACEF-STEMI, for MACE within 2 years. The AUC was used to assess discriminative ability. B ROC curves demonstrating the predictive performance of the newly developed mACEF-Ca model compared with ACEF-STEMI score. The mACEF-Ca score showed superior AUC compared to traditional models, reflecting improved predictive accuracy for MACE in patients with severe CAC. ROC, Receiver operating characteristic; MACE, major adverse cardiovascular events; AUC, area under the curve; CAC, coronary artery calcification

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  Fig. 4. Kaplan–Meier survival curves and diagnostic performance of the mACEF-Ca scoring system.Kaplan–Meier analysis was performed using both the continuous mACEF-Ca model and the simplified clinical score. The continuous model showed superior discriminative ability with an AUC of 0.778 (cutoff = 0.501), while the simplified score achieved an AUC of 0.649 (cutoff = 1.961) with improved specificity and clinical usability. The lower portion of the figure summarizes the diagnostic performance characteristics of each scoring method. AUC, area under the curve; MACE, major adverse cardiovascular events; HR, hazard ratio; CI, confidence interval