ACEF score in the risk stratification of patients undergoing percutaneous coronary interventions of chronic coronary total occlusion

Abstract

Purpose: The Age, Creatinine, and Ejection Fraction (ACEF) score can reliably predict clinical outcomes in patients undergoing elective coronary artery bypass surgery. However, its utility in patients undergoing percutaneous coronary intervention of a chronic total occlusion is not known. Methods: ACEF score was calculated in 308 consecutive patients treated with PCI of CTO between January 2008 and June 2012. Patients with successful recanalization of CTO were divided according to the ACEF score tertiles: ACEFlow ≤ 0.89 (n=80, 26%), ACEFmid 0.90-1.10 (n=68, 22%), and ACEFhigh > 1.10 (n=73, 24%). Patients with failed recanalization were excluded from the analysis (n=87 [28%]). Follow up was available in 206 patients (93%) with a median of 25 months (10-37). Clinical endpoints assessed at the follow-up were major adverse cardiovascular events (MACE), overall death, non-fatal myocardial infarction (MI) and target vessel revascularization (TVR). Results: The 3 groups did not differ significantly with respect to the angiographic characteristics. At the follow-up, MACE rate was significantly lower in the lowest ACEF score tertile (ACEFlow = 7%, ACEFmid = 14%, ACEFhigh = 21%, HR: 0.46 (0.26-0.81), p<0.01). At Kaplan-Mayer analysis, MACE-free survival was significantly higher in the lowest ACEF score tertiles (Log-Rank: 5.36, p<0.01). This difference in outcome was mainly driven by lower TVR rate in the ACEFlow group (ACEFlow = 3%, ACEFmid = 9%, ACEFhigh = 15%, HR: 0.47 (0.25-0.87), p=0.02). No significant difference was found both in death and non-fatal MI. Conclusions: ACEF score represents a simple tool in the prognostication of patients treated with PCI of CTO. In addition, it provides the evidence about the benefit of revascularization of a CTO in patients with the lowest ACEF score.