ACEF performed better than other risk scores in non-ST-elevation acute coronary syndrome during long term follow-up

Abstract

Background Risk stratification of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) is an important clinical method, but long-term studies on patients subjected to all-treatment strategies are lacking. Therefore, the aim was to compare several established risk scores in the all-treatment NSTE-ACS cohort during long-term follow-up. Methods Consecutive patients (n = 276) with NSTE-ACS undergoing coronary angiography were recruited between September 2012 and May 2015. Six risk scores for all patients were calculated, namely GRACE 2.0, ACEF, SYNTAX, Clinical SYNTAX, SYNTAX II PCI and SYNTAX II CABG. The primary end-point was Major Adverse Cardiovascular Events (MACE) which was a composite of cardiac death, nonfatal myocardial infarction, ischemic stroke or urgent coronary revascularization. Results During a median follow-up of 33 months, 64 MACE outcomes were recorded (23.2%). There was no difference between risk score categories, except in the highest risk group of ACEF and SYNTAX II PCI scores which exhibited significantly more MACE (51.6%, N = 33 and 45.3%, N = 29, P = 0.024, respectively). In the multivariate Cox regression analysis of individual variables, only age and atrial fibrillation were significant predictors for MACE (HR 1.03, 95% CI 1.00–1.05, P = 0.023 and HR 2.02, 95% CI 1.04–3.89, P = 0.037, respectively). Furthermore, multivariate analysis of the risk scores showed significant prediction of MACE only with ACEF score (HR 2.16, 95% CI 1.36–3.44, P = 0.001). The overall performance of GRACE, SYNTAX, Clinical SYNTAX and SYNTAX II CABG was poor with AUC values of 0.596, 0.507, 0.530 and 0.582, respectively, while ACEF and SYNTAX II PCI showed the best absolute AUC values for MACE (0.630 and 0.626, respectively). Conclusions ACEF risk score showed better discrimination than other risk scores in NSTE-ACS patients undergoing all-treatment strategies over long-term follow-up and it could represent a fast and user-friendly tool to stratify NSTE-ACS patients.

Prognostic value of age, creatinine, and left ventricular ejection fraction risk score in patients evaluated with fractional flow reserve: a cross-sectional study

“…In this respect, we wanted to examine its effect on quantitative data, and to the best of our knowledge, this is the first study in the literature. In a study, it was reported that the ACEF risk score was a better predictor than other risk scores in patients with non-ST-elevation MI in whom all treatment strategies were applied 11 . In another study, it was reported that the ACEF value at admission could predict the 1 month and 1 year cardiac mortality rate after emergency PCI in STEMI patients aged ≥75 years 12 .…”

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

“…Afterward, different models were created for patients with ACS by combining the ACEF score with various clinical and angiographic variables, which enhanced the power of this scoring scheme to predict outcomes [ 28 – 31 ]. On the other hand, in a recent study by Kristić et al with NSTEMI patients, the ACEF score showed better discrimination than the other six clinical, angiographic, or combined risk scores [ 32 ].…”

Risk Prediction Models for Ischemic Cardiovascular Outcomes in Patients with Acute Coronary Syndrome

“…The ACEF score has an independent predictive effect on 1-year mortality with a strong AUC of 0.79, according to data from the Korean Acute Myocardial Infarction Registry, which included data from an ACS cohort undergoing percutaneous coronary intervention (PCI) [45]. When applied to patients with a non-ST-elevation ACS (NSTE-ACS), it demonstrated superior discrimination compared to other complex risk stratification models [46].…”