Prediction of 5-year Mortality in Invasively Managed NSTE-ACS Patients: Role of the Age, Creatinine, And Ejection Fraction (ACEF) Score

Abstract

Background: Long-term risk stratification in non-ST-elevation acute coronary syndrome (NSTE-ACS) by the ACEF score has not yet been assessed. The ACEF score (age/left ventricular ejection fraction +1 [if creatinine > 20 mg/l]) has been established in patients evaluated for coronary artery bypass surgery.Methods: This is a prospective observational study, including 196 NSTE-ACS patients with invasive management and completing a 5-year follow-up after hospital discharge. ACEF score was calculated at admission. The primary endpoint was 5-year all-cause death. The secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE). The overall population was divided into tertiles of ACEF score (low, mid, and high ACEF score). The discrimination of the ACEF score was assessed by receiver operating characteristic curves and associated area under the curve (AUC) and evaluated in a multivariate analysis.Results: Patients in the ACEF-High tertile showed the highest incidence of death at 5 years (43.1% vs. 3.1% in ACEF-Low and 16.4% in ACEF-Mid; log-rank p < 10 -3 ). The ACEF score could significantly discriminate between patients who died and those who were still alive at 5 years (AUC 0.79, 95%CI 0.72-0.86), and an ACEF score ≥ 1.22 was identified as the optimal cutoff point to predict 5-year mortality (sensitivity 82.9%, specificity 69.7%). An ACEF score ≥ 1.22 was an independent predictor of 5-year mortality (HR 10.98, ). Conclusions:The ACEF score is a simple and useful tool for long-term risk stratification in NSTE-ACS patients.