Key result
Higher ACEF score linked to ~275% greater 1-year MACCE risk.
Why the study?
It was unclear whether the ACEF score predicts 1-year outcomes following STEMI after PCI, and whether predictive accuracy could be improved by novel ACEF-derived models.
Does the ACEF-diabetes score improve prediction of 1-year major adverse cardio-cerebrovascular events in patients with STEMI undergoing PCI compared to the original ACEF score?
Cohort (n=1,146)
Does the ACEF-diabetes score improve prediction of 1-year major adverse cardio-cerebrovascular events in patients with STEMI undergoing PCI compared to the original ACEF score?
Odds Ratio: 3.75 (95% CI 2.44–5.77)
p-value: p=<0.001
The novel ACEF-diabetes score improves the prediction of 1-year major adverse cardio-cerebrovascular events in STEMI patients undergoing PCI compared to the standard ACEF score.
ACEF score was associated with higher 1-year MACE in STEMI PCI patients; supports further validation of ACEF-diabetes for improved prediction.
BACKGROUND: This study investigated whether the age, creatinine, and ejection fraction (ACEF) score [age (years) /ejection fraction (%) +1 (if creatinine>176μmol/L)] could predict 1-year outcomes following ST-segment elevation myocardial infarction after percutaneous coronary intervention, and whether accuracy could be improved by establishing novel ACEF-derived risk models. METHODS: A total of 1146 patients were included. The study endpoint was 1-year major adverse cardio-cerebrovascular events, including all-cause death, nonfatal myocardial infarction, unplanned revascularization, and nonfatal stroke. Accuracy was defined with area under the curve by receiver-operating characteristic curve analysis. RESULTS: The incidence of 1-year major adverse cardio-cerebrovascular event increased with the rising age, creatinine, and ejection fraction score tertiles (4.8%, 8.4%, and 15.2%, P < 0.001 for all). Higher ACEF score was significantly associated with an increased risk of the endpoint in overall (odds ratio = 3.75, 95% confidence interval, 2.44-5.77, P < 0.001) and in subgroups (all P < 0.05). The accuracy of the ACEF score was equivalent to the other complex risk scores. The combination of ACEF, and diabetes (ACEF-diabetes score) yielded a superior discriminatory ability than the original ACEF score (increase in C-statistic from 0.67 to 0.71, P = 0.048; continuous net reclassification improvement = 51.9%, 95% confidence interval, 33.4-70.5%, P < 0.001; integrated discrimination improvement = 0.020, 95% confidence interval, 0.011-0.030, P < 0.001). CONCLUSIONS: The simplified ACEF score performed well in predicting 1-year outcomes in ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention. The novel ACEF-diabetes score provided a better predictive value and thus may help stratify high-risk patients and potentially facilitate decision making.
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Gao et al. (2019) conducted a cohort in ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention (n=1,146). Higher ACEF score vs. Lower ACEF score was evaluated on 1-year major adverse cardio-cerebrovascular events (all-cause death, nonfatal myocardial infarction, unplanned revascularization, and nonfatal stroke) (OR 3.75, 95% CI 2.44-5.77, p=<0.001). A higher ACEF score was significantly associated with an increased risk of 1-year major adverse cardio-cerebrovascular events (OR 3.75; 95% CI 2.44-5.77; P<0.001).
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