Key result
ACEF-II score predicts ~41% higher 1-year MACE risk in NSTEMI-ACS.
Why the study?
The ACEF-II score was proposed for risk stratification in cardiac surgery, but its utility for predicting 1-year MACE in patients with NSTEMI and unstable angina needed evaluation.
Does the ACEF-II score predict 1-year major adverse cardiac events in patients with non-ST-segment elevation myocardial infarction and unstable angina?
Cohort (n=768)
Does the ACEF-II score predict 1-year major adverse cardiac events in patients with non-ST-segment elevation myocardial infarction and unstable angina?
Effect estimate: OR 1.41 (95% CI 1.12-1.81)
p-value: p=0.005
The ACEF-II score is a useful and easy-to-calculate tool for predicting 1-year major adverse cardiac events in patients with NSTEMI-ACS.
May support ACEF-II for NSTEMI-ACS risk stratification; leaves open routine adoption pending prospective validation.
Background: A score based on age, creatinine level, and ejection fraction as well as hematocrit value and the presence of emergency surgery (ACEF-II) has been proposed to have predictive value for risk stratification in cardiac surgery. This study aimed to evaluate its utility in patients with non–ST-segment elevation myocardial infarction and unstable angina (NSTEMI-ACS) to predict 1-year major adverse cardiac events (MACE). Methods: In all, 768 patients with NSTEMI-ACS were enrolled in the study. After propensity score matching, the MACE and control groups comprised 168 patients each. Blood samples were drawn from patients during emergency department admission and hospitalization. The Global Registry of Acute Coronary Events, Acute Coronary Treatment and Intervention Outcome Network Intensive Care Unit risk, ACEF, and ACEF-II scores of each patient were evaluated. Results: Mean (SD) age of the study population was 63.07 (12.39) years; 547 (71.2%) patients were male. After propensity score matching for 7 variables, a comparison of the matched groups revealed that patients with MACE had higher heart rates and rates of ST-segment deviation, cardiac arrest, and creatinine levels and lower left ventricular ejection fraction and albumin, hemoglobin, hematocrit, systolic blood pressure, and oxygen saturation values. Multivariate logistic regression analysis revealed that ACEF-II score had the highest odds ratio of the evaluated scores, at 1.41 (95% CI, 1.12-1.81; P = .005). The ACEF score did not reach statistical significance for the prediction of 1-year MACE according to multivariate analysis. In addition to type of risk score, left ventricular ejection fraction and heart rate had predictive value for 1-year MACE. An ACEF-II score cutoff of 1.82 predicted 1-year MACE, with a sensitivity of 61.2% and a specificity of 76.2%. Conclusion: ACEF-II score, which is easy to calculate, could be used to predict 1-year MACE in patients with NSTEMI-ACS.
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Ayça et al. (2024) conducted a cohort in Non-ST-segment elevation myocardial infarction and unstable angina (NSTEMI-ACS) (n=768). ACEF-II score vs. ACEF score, GRACE score, and ACTION ICU risk score was evaluated on 1-year major adverse cardiac events (MACE) (OR 1.41, 95% CI 1.12-1.81, p=0.005). The ACEF-II score significantly predicted 1-year major adverse cardiac events in patients with NSTEMI-ACS (OR 1.41; 95% CI 1.12-1.81; P=0.005).
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