The ACEF (age, creatinine, ejection fraction) score as a prognostic marker in acute coronary syndrome

    Authors

    Keywords

    ACEF score, acute coronary syndrome, ejection fraction, creatinine

    DOI

    https://doi.org/10.15836/ccar2024.371

    Full Text

    **Introduction**: Studies have shown that age, serum creatinine levels, and left ventricular ejection fraction (LVEF) combined in ACEF score have predictive value for clinical outcomes in patients undergoing elective coronary artery bypass surgery and promising value for those undergoing percutaneous coronary interventions (PCI) (1-3). The aim of this study was to investigate the prediction value of ACEF score for a novel major adverse cardiovascular events (MACE) and cardiovascular (CV) death in patients with acute coronary syndrome (ACS). **Patients and Methods**: We included patients hospitalized at Dubrava University Hospital with ACS from January 2017 to January 2024. Data involving baseline demographic characteristics, laboratory results on admission, comorbidities, ACS type and MACE were collected. The ACEF score was calculated using the formula: age (years)/LVEF (%) +1(if baseline serum creatinine was>176 µmol/L). MACE was defined as a composite of novel ACS and need for elective or urgent percutaneous or surgical revascularization. Follow-up data were collected by clinical visits or telephone interviews. **Results**: This registry-based study included 1414 ACS patients with median age of 64 years (IQR 56-72), 70% male. Total of 817 (58%) patients had ST elevation myocardial infarction (STEMI). Median follow up was 16 months (IQR 4-36). Median serum creatinine levels were 81 µmol/L (IQR 69-96) and LVEF 55% (IQR 45-60). ACEF score ranged from 0.436 to 5.533 with median of 1.181 (IQR 1.00-1.454). Patients were devided into tertiles based on ACEF score (low ≤1,000 (n376); 1,000> mid ≤1,454 (n686), high ≥1,454(n352)). ACEF score correlated significantly both with CV death (HR 31.17, 95%CI 15.58 -74.12, p<0.05) and with MACE (HR 21.28, 11.24-98.04, p<0.001), with AICcWt severity 0. **Conclusion**: Our data suggest that ACEF score has significant correlation with MACE and CV death in ACS patients, but more patients with diverse ACEF score must be included to confirm its real prediction value.

    Literature

    1. Wykrzykowska JJ, Garg S, Onuma Y, de Vries T, Goedhart D, Morel MA, et al. Value of age, creatinine, and ejection fraction (ACEF score) in assessing risk in patients undergoing percutaneous coronary interventions in the ‘All-Comers’ LEADERS trial. Circ Cardiovasc Interv. 2011 February 1;4(1):47–56. https://doi.org/10.1161/CIRCINTERVENTIONS.110.958389
    2. Dziewierz A, Siudak Z, Rakowski T, Zasada W, Krzanowska K, Dudek D. The ACEF (age, creatinine, ejection fraction) score predicts ischemic and bleeding outcomes of patients with acute coronary syndromes treated conservatively. Postepy Kardiol Interwencyjnej. 2017;13(2):160–4. https://doi.org/10.5114/pwki.2017.68209
    3. Biondi-Zoccai G, Romagnoli E, Castagno D, Sheiban I, De Servi S, Tamburino C, et al. Simplifying clinical risk prediction for percutaneous coronary intervention of bifurcation lesions: the case for the ACEF (age, creatinine, ejection fraction) score. EuroIntervention. 2012 July 20;8(3):359–67. https://doi.org/10.4244/EIJV8I3A55
    Cardiologia Croatica
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    The ACEF (age, creatinine, ejection fraction) score as a prognostic marker in acute coronary syndrome

    Extended Abstract
    Issue11-12
    Published
    Pages371
    PDF via DOIhttps://doi.org/10.15836/ccar2024.371
    ACEF score
    acute coronary syndrome
    ejection fraction
    creatinine

    Authors

    Martina God*ORCIDDubrava University Hospital Zagreb, Croatia
    Ivan ZeljkovićORCIDDubrava University Hospital Zagreb, Croatia
    Šime ManolaORCIDDubrava University Hospital Zagreb, Croatia
    Nikola PavlovićORCIDDubrava University Hospital Zagreb, Croatia
    Marin PavlovORCIDDubrava University Hospital Zagreb, Croatia
    Irzal HadžibegovićORCIDDubrava University Hospital Zagreb, Croatia
    Tomislav ŠipićORCIDDubrava University Hospital Zagreb, Croatia
    Aleksandar BlivajsORCIDDubrava University Hospital Zagreb, Croatia
    Mario UdovičićORCIDDubrava University Hospital Zagreb, Croatia
    Ana JordanORCIDDubrava University Hospital Zagreb, Croatia
    Andrej NovakORCIDUniversity of Zagreb, Faculty of Science, Zagreb, Croatia
    Ivana JurinORCIDDubrava University Hospital Zagreb, Croatia

    *Correspondence email: martina.god@gmail.com

    Full Text

    Introduction: Studies have shown that age, serum creatinine levels, and left ventricular ejection fraction (LVEF) combined in ACEF score have predictive value for clinical outcomes in patients undergoing elective coronary artery bypass surgery and promising value for those undergoing percutaneous coronary interventions (PCI) (1–3). The aim of this study was to investigate the prediction value of ACEF score for a novel major adverse cardiovascular events (MACE) and cardiovascular (CV) death in patients with acute coronary syndrome (ACS).

    Patients and Methods: We included patients hospitalized at Dubrava University Hospital with ACS from January 2017 to January 2024. Data involving baseline demographic characteristics, laboratory results on admission, comorbidities, ACS type and MACE were collected. The ACEF score was calculated using the formula: age (years)/LVEF (%) +1(if baseline serum creatinine was>176 µmol/L). MACE was defined as a composite of novel ACS and need for elective or urgent percutaneous or surgical revascularization. Follow-up data were collected by clinical visits or telephone interviews.

    Results: This registry-based study included 1414 ACS patients with median age of 64 years (IQR 56-72), 70% male. Total of 817 (58%) patients had ST elevation myocardial infarction (STEMI). Median follow up was 16 months (IQR 4-36). Median serum creatinine levels were 81 µmol/L (IQR 69-96) and LVEF 55% (IQR 45-60). ACEF score ranged from 0.436 to 5.533 with median of 1.181 (IQR 1.00-1.454). Patients were devided into tertiles based on ACEF score (low ≤1,000 (n376); 1,000> mid ≤1,454 (n686), high ≥1,454(n352)). ACEF score correlated significantly both with CV death (HR 31.17, 95%CI 15.58 -74.12, p<0.05) and with MACE (HR 21.28, 11.24-98.04, p<0.001), with AICcWt severity 0.

    Conclusion: Our data suggest that ACEF score has significant correlation with MACE and CV death in ACS patients, but more patients with diverse ACEF score must be included to confirm its real prediction value.

    Literature

    1. 1.
      Wykrzykowska JJ, Garg S, Onuma Y, de Vries T, Goedhart D, Morel MA, et al. Value of age, creatinine, and ejection fraction (ACEF score) in assessing risk in patients undergoing percutaneous coronary interventions in the ‘All-Comers’ LEADERS trial. Circ Cardiovasc Interv. 2011 February 1;4(1):47–56.DOI
    2. 2.
      Dziewierz A, Siudak Z, Rakowski T, Zasada W, Krzanowska K, Dudek D. The ACEF (age, creatinine, ejection fraction) score predicts ischemic and bleeding outcomes of patients with acute coronary syndromes treated conservatively. Postepy Kardiol Interwencyjnej. 2017;13(2):160–4.DOI
    3. 3.
      Biondi-Zoccai G, Romagnoli E, Castagno D, Sheiban I, De Servi S, Tamburino C, et al. Simplifying clinical risk prediction for percutaneous coronary intervention of bifurcation lesions: the case for the ACEF (age, creatinine, ejection fraction) score. EuroIntervention. 2012 July 20;8(3):359–67.DOI