Predictive value of the age, creatinine and ejection fraction score in patients undergoing primary percutaneous coronary intervention with bail-out tirofiban therapy

Q: What is the clinical evidence from this study?

Study design: Observational. Population: ST-elevation myocardial infarction (STEMI) (n=2543). Intervention: High ACEF score (Tertile 3: > 1.371) vs. Low ACEF score (Tertile 1: ≤ 1.033). Primary outcome: 30-day Bleeding Academic Research Consortium (BARC) grades 3, 4, or 5 bleeding events (OR 2.56, 95% CI 1.37-4.80).

Q: What does this research mean for the field?

A high ACEF score is significantly associated with increased 30-day major bleeding and increased short- and long-term mortality in STEMI patients undergoing primary PCI with bail-out tirofiban therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Altuğ Ösken; Recep Hacı; Sena Sert Şekerci; Lale Dinç Asarcıklı; Gizem Yüksel; Büşra Ceylan; Şennur Ünal Dayı; Neşe Çam

doi:10.5114/aic.2021.107495

January 1, 2021Advances in Interventional CardiologyOpen Access

Predictive value of the age, creatinine and ejection fraction score in patients undergoing primary percutaneous coronary intervention with bail-out tirofiban therapy

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Key result

High ACEF score linked to ~2.6-fold higher 30-day major bleeding in STEMI treated with tirofiban.

OR 2.56
95% CI 1.37-4.80
n=2,543

Why the study?

The usefulness of the ACEF score for predicting bleeding events and clinical outcomes in STEMI patients undergoing primary PCI with bail-out tirofiban therapy was unclear.

Key Points

To assess the predictive value of the age, creatinine, and ejection fraction (ACEF) score for bleeding events and short- and long-term mortality in patients with STEMI undergoing primary PCI with bail-out tirofiban therapy.
Analyzed 2,543 patients undergoing primary PCI with bail-out tirofiban therapy, divided into ACEF score tertiles: T1 (≤ 1.033, n = 848), T2 (1.033–1.371, n = 847), and T3 (> 1.371, n = 848).
Evaluated primary endpoints including Bleeding Academic Research Consortium (BARC) grades 3–5 bleeding events and all-cause mortality at 30 days and 3 years post-procedure.
Within 30 days post-procedure, 73 (2.9%) patients experienced BARC grade 3–5 bleeding and 104 (4%) patients died.
The ACEF score effectively predicted 30-day bleeding (AUC = 0.658, 95% CI: 0.579–0.737; p < 0.001), 30-day mortality (AUC = 0.701, 95% CI: 0.649–0.753; p < 0.001), and 3-year mortality (AUC = 0.778, 95% CI: 0.748–0.807; p < 0.001).
Compared to T1, patients in T3 had significantly higher risks of 30-day bleeding (4.1% vs. 1.6%; OR = 2.56, 95% CI: 1.37–4.80), 30-day mortality (7.1% vs. 1.7%; OR = 4.53, 95% CI: 2.51–8.18), and 3-year mortality (19.8% vs. 6.4%; HR = 3.56, 95% CI: 2.58–4.91).

Study Design

Type

Observational (n=2,543)

Multicenter

No

PICO

P

Population

2,543 patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with bail-out tirofiban therapy, followed for up to 3 years.

E

Exposure / Comparator

High ACEF score (Tertile 3: > 1.371) vs Low ACEF score (Tertile 1: ≤ 1.033)

O

Primary Outcome

30-day Bleeding Academic Research Consortium (BARC) grades 3, 4, or 5 bleeding events — OR 2.56 (1.37-4.80)

Main Result

Odds Ratio: 2.56 (95% CI 1.37–4.8)

Absolute Event Rate: 4.1% vs 1.6%

Limitations

Retrospective observational study design.
Conducted at a single center.
Did not incorporate bleeding risk-scoring systems that include clinic and angiographic variables.
BARC 3-5 bleeding events were only analyzed within the 30-day follow-up period, rather than long-term.

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Implication

May flag higher bleeding risk with bail-out tirofiban in STEMI PCI; leaves open added value for risk stratification pending prospective validation.

Abstract

Introduction: In patients who have undergone interventional cardiac procedures, the risk of bleeding is higher than in patients who received conservative treatment due to multiple medications and comorbidities.Aim: This study aimed to evaluate the usefulness of the age, creatinine and ejection fraction (ACEF) score for predicting bleeding events and to compare short-and long-term clinical outcomes according to the ACEF score in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) with bail-out tirofiban therapy (BOTT).Material and methods: A total of 2,543 patients were included and divided into three groups according to the following ACEF score tertiles: T1 (ACEF low ≤ 1.033), T2 (1.033 < ACEF mid ≤ 1.371), and T3 (ACEF high > 1.371).The main outcomes measured were the incidence rates of relevant bleeding events and mortality within 30 days and 3 years after the procedure.Results: A total of 73 (2.9%) patients had Bleeding Academic Research Consortium bleeding events of grades 3, 4 or 5 and 104 (4%) patients died in a 30-day period.The ACEF score was effective at predicting 30-day bleeding (area under the receiver operating characteristic curve (AUC): 0.658, 95% confidence interval (CI): 0.579-0.737;p < 0.001), 30-day mortality (AUC = 0.701, 95% CI: 0.649-0.753;p < 0.001) and 3-year mortality (AUC = 0.778, 95% CI: 0.748-0.807;p < 0.001) events.Considering the ACEF score tertiles, T3 patients presented greater 30-day bleeding (1.6%, 2.8% and 4.1%; odds ratio (OR) = 2.56, 95% CI: 1.37-4.80),30-day mortality (1.7%, 3.5% and 7.1%; OR = 4.53, 95% CI: 2.51-8.18)and 3-year mortality (6.4%, 11% and 19.8%; hazard ratio = 3.56, 95% CI: 2.58-4.91)risks. Conclusions:The ACEF score is a user-friendly tool with excellent predictive value for bleeding events and mortality in patients undergoing pPCI with BOTT.

Discussion

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Cite This Study

Ösken et al. (2021) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=2,543). High ACEF score (Tertile 3: > 1.371) vs. Low ACEF score (Tertile 1: ≤ 1.033) was evaluated on 30-day Bleeding Academic Research Consortium (BARC) grades 3, 4, or 5 bleeding events (OR 2.56, 95% CI 1.37-4.80). A high ACEF score was associated with increased 30-day major bleeding compared to a low score in STEMI patients undergoing primary PCI with bail-out tirofiban therapy.

synapsesocial.com/papers/6ad165e3328c43d3fbb670bd https://doi.org/10.5114/aic.2021.107495

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Predictive value of the age, creatinine and ejection fraction score in patients undergoing primary percutaneous coronary intervention with bail-out tirofiban therapy

Key Points

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Predictive value of the age, creatinine and ejection fraction score in patients undergoing primary percutaneous coronary intervention with bail-out tirofiban therapy

Key Points

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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