Simplifying clinical risk prediction for percutaneous coronary intervention of bifurcation lesions: The case for the ACEF (age, creatinine, ejection fraction) score

Francesco Burzotta, Franco Glieca, Elisa Romagnoli, Pasquale Rubino, Davide Castagno, Imad Sheiban, Corrado Tamburino, Antonio Colombo, Patrizia Presbitero, Leonardo Bolognese, Leonardo Paloscia, Paolo Rubino, Gennaro Sardella, Carlo Briguori, Luigi Niccoli, Gianfranco Franco, Domenico D. Di Girolamo, Luigi Piatti, Cesare Greco, A. Sonia PetronioBruno Loi, Alberto Benassi, Aldo Patti, Achille Gaspardone, Giacomo Frati

Risultato della ricerca: Contributo in rivistaArticolo in rivista

19 Citazioni (Scopus)

Abstract

Aims: We aimed to appraise the predictive accuracy of a novel and user-friendly risk score, the ACEF (age, creatinine, ejection fraction), in patients undergoing PCI for coronary bifurcations. Methods and results: A multicentre, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and December 2006 in 22 Italian centres. Patients with complete data to enable computation of the ACEF score were divided into three groups according to tertiles of ACEF score. The primary endpoint was 30-day mortality. The discrimination of the ACEF score as a continuous variable was also appraised with area under the curve (AUC) of the receiver-operating characteristic. A total of 3,535 patients were included: 1,119 in the lowest tertile of ACEF score, 1,190 in the mid tertile, and 1,153 in the highest tertile. Increased ACEF score was associated with significantly different rates of 30-day mortality (0.1% in the lowest tertile vs. 0.5% in the mid tertile and 3.0% in the highest tertile, p<0.001), with similar differences in myocardial infarction (0.3% vs. 0.7% and 1.8%, p<0.001) and major adverse cardiac events (MACE, 0.5% vs. 1.2% and 4.3%, p<0.001). After an average follow-up of 24.4±15.1 months, increased ACEF score was still associated with a higher rate of all-cause death (1.3% vs. 2.4% and 11.0%, p<0.001), cardiac death (0.9% vs. 1.4% and 7.2%, p<0.001), myocardial infarction (3.4% vs. 2.7% and 5.7%, p<0.001), MACE (13.6% vs. 15.9% and 22.3%, p<0.001), and stent thrombosis (2.3% vs. 1.8% and 5.0%, p<0.001). Discrimination of ACEF score was satisfactory for 30-day mortality (AUC=0.82 [0.77-0.87], p<0.001), 30-day MACE (AUC=0.73 [0.67-0.78], p<0.001), long-term mortality (AUC=0.77 [0.74-0.81], p<0.001), and moderate for long-term MACE (AUC=0.60 [0.57-0.62], p<0.001). Conclusions: The simple and extremely user-friendly ACEF score can accurately identify patients undergoing PCI for coronary bifurcation lesions at high risk of early fatal or non-fatal complications, as well as long-term fatality. © Europa Edition 2012. All rights reserved.
Lingua originaleEnglish
pagine (da-a)359-367
Numero di pagine9
RivistaEuroIntervention
Volume8
DOI
Stato di pubblicazionePubblicato - 2012

Keywords

  • Age Factors
  • Aged
  • Angioplasty, Balloon, Coronary
  • Bifurcation
  • Coronary Artery Disease
  • Coronary artery disease
  • Creatinine
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Risk score
  • Stent
  • Stroke Volume

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