Age, Creatinine, And Ejection Fraction Score Research Articles

Clinical predictive value of the age, creatinine, and ejection fraction score in patients in acute type A aortic dissection after total arch replacement

The age, creatinine, and ejection fraction (ACEF) score has been accepted as a predictor of poor outcome in elective operations. This study aimed to investigate the predictive value of ACEF score in acute type A aortic dissection (AAAD) patients after total arch replacement. A total of 227 AAAD patients from July 2021 and June 2022 were enrolled and divided into Tertiles 1 (ACEF ≤ 0.73), Tertiles 2 (0.73 < ACEF ≤ 0.95), and Tertiles 3 (ACEF > 0.95). Using inverse probability processing weighting (IPTW) to balance the baseline characteristics and compare the outcomes. Cox logistic regression was used to further evaluate the survival prediction ability of ACEF score. The in-hospital mortality was 9.8%. After IPTW, in the baseline characteristics reached an equilibrium, a higher ACEF score before operation still associated with higher in-hospital mortality. After 1 year follow-up, 184 patients (90.6%) survival. Multivariable analysis revealed that ACEF score (adjusted hazard ratio 1.68; 95% confidence interval 1.34–4.91; p = 0.036) and binary ACEF score (adjusted HR 2.26; 95% CI 1.82–6.20; p < 0.001) was independently associated with 1-year survival. In addition, net reclassification improvement (NRI) and integrated differentiation improvement (IDI) verified that the ACEF score and binary ACEF score is an accurate predictive tool in clinical settings. In conclusions, ACEF score could be considered as a useful tool to risk stratification in patients with AAAD before operation in daily clinical work.

Predictive value of ACEF score for acute kidney injury after surgical aortic valve replacement

Objectives: Aortic stenosis is the most common form of degenerative heart valve disease. Acute kidney injury (AKI) after aortic valve replacement (AVR) is a common complication and is related to worse outcomes. Age, creatinine, and ejection fraction (ACEF) score is a simple scoring method that includes three parameters. Our study aimed to evaluate whether ACEF score could predict the development of AKI in patients who underwent AVR. Methods: A total of 366 consecutive patients who underwent isolated AVR for symptomatic severe aortic stenosis were evaluated retrospectively. The development of AKI was the primary endpoint of the study. The ACEF score was calculated by the formula: age (years)/left ventricular ejection fraction (%) + 1 (if baseline serum creatinine was &amp;gt;2 mg/dL). According to the ACEF score the study population was divided into two groups. Results: AKI was developed in 66 (18%) patients. The cut-off value of the ACEF score for the prediction of AKI was 1.07 with a sensitivity of 69.7% and a specificity of 56.7% (AUC 0.663; 95% CI: 0.589-0.736; P&amp;lt;0.001). AKI incidence was found to be higher in patients with high ACEF score than low ACEF score [46 (26.1%) vs. 20 (10.5%); P&amp;lt;0.001]. In addition, ACEF score [OR: 2.599; 95% CI: 1.399-4.828; P=0.002] and hemoglobin levels (OR: 0.837; 95% CI: 0.729-0.961; P=0.012) were found to be independent predictors of AKI. Conclusions: Our study revealed that the ACEF score is an independent predictor of AKI. ACEF score, as a simple and objective score, can be useful in predicting AKI in patients undergoing AVR.

Predictive value of lung ultrasound combined with ACEF score in patients with acute myocardial infarction

Abstract Objectives Acute myocardial infarction (AMI) with pulmonary edema shows a worse prognosis. Lung ultrasound (LUS) determines the severity of pulmonary edema by measuring the number of B-lines and has been proved to be of great significance in predicting the poor prognosis of AMI. ACEF (Age, Creatinine, and Ejection Fraction) score has been validated as effective predictor for prognosis in patients undergoing elective cardiac surgery or percutaneous coronary intervention (PCI). However, whether lung ultrasound combined with ACEF score has incremental value in predicting the prognosis of patients with AMI is still unclear. This study aimed to investigate their predictive value in patients with AMI. Methods We performed preoperative echocardiography and LUS in patients with AMI who underwent emergency PCI in our hospital from February 2021 to June 2022，collected clinical data from all patients and conducted ACEF score [ACEF score formula: age/ejection fraction + 1 (if creatinine&amp;gt;176 μmol/L)]. The lung water detected by LUS was defined as B-lines, and the sum of the B-line number from 8 chest zones was calculated. Besides, the classification into LUS according to the pulmonary edema severity was as follows: normal (B-line numbers &amp;lt;5), mild (B-line numbers ≥5 and &amp;lt;15), moderate (B-line numbers ≥15 and &amp;lt;30), and severe (B-line numbers ≥30). The adverse events were defined as all-cause death, recurrent myocardial infarction, Myocardial ischemia induced revascularization, and heart failure. Results 224 patients were enrolled, and the average length of hospital stay was 9.71±8.99 days. The ACEF score was positively correlated with the number of B lines (r = 0.43, P&amp;lt;0.01) and NT-proBNP (r =0.66, P&amp;lt;0.01) during hospitalization，The number of B-lines was positively correlated with NT-proBNP (r =0.38, P&amp;lt;0.01). In multivariate Logistic regression analysis, the number of B-lines during hospitalization (OR 1.093 [95%CI: 1.048-1.140], P&amp;lt;0.01) and ACEF score (OR 3.974 [95%CI: 1.680-9.400], P&amp;lt;0.01) were independent predictors of adverse events in AMI patients during hospitalization. For in-hospital results, the area under the receiver operating characteristic curves (AUCs) of ACEF score, LUS and their combination were 0.825 (P&amp;lt;0.01), 0.821(P&amp;lt; 0.01) and 0.880(P&amp;lt;0.01), respectively. 169 patients were followed up for an average of 11.00±6.52 months. In multivariate Cox analysis, the number of B-lines (HR 1.045 [95%CI: 1.023-1.069], P&amp;lt;0.01) and ACEF score (HR 1.649, 95%CI 1.103-2.463, P&amp;lt;0.05) were related with increasing risks of adverse events during follow-up. The area under the AUCs of ACEF score, LUS and their combination were 0.712 (P&amp;lt;0.01), 0.730(P&amp;lt; 0.01) and 0.755(P&amp;lt;0.01), respectively. Conclusions The number of B-lines combined with ACEF score provides incremental value for the risk of adverse events in patients, which is of great significance for risk stratification of patients with AMI.ROC curve during hospitalizationROC curve during follow-up

Age, creatinine, and ejection fraction (ACEF) score as predictive values for late non-valvular atrial fibrillation recurrence after radiofrequency ablation

ABSTRACT The clinical risk factors associated with late recurrence in patients with non-valvular atrial fibrillation (AF) (NVAF) undergoing radiofrequency catheter ablation (RFCA) remain unknown. Furthermore, the current prognostic risk score system is commonly used in such patients as a noninvasive method to assess late AF recurrence. According to recent research, the Age, creatinine, and ejection fraction (ACEF) score is a useful risk score for cardiovascular morbidity and mortality. As a result, we hypothesized that pre-ablation ACEF score could be used to assess late recurrence in patients with NVAF. We included 325 NVAF patients undergoing RFCA. During a median follow-up period of 12 months, patients with late AF recurrence had higher ACEF scores (P < .001). The pre-ablation ACEF score was a risk factor for late AF recurrence after RFCA (P = .027). The ACEF score was a predictor of late AF recurrence after RFCA, with an AUC of 0.624 (P = .001). Moreover, the AUC of left atrial diameter (LAD) was 0.7 (P < .001), which was higher than the ACEF score, but no significant difference was found (P = .104). The ACEF score was positively correlated with LAD, advanced age, and B-type natriuretic peptide. In patients with NVAF, the pre-ablation ACEF score is a valuable risk score for assessing late AF recurrence after RFCA, as with LAD.

Predictive Value of a Combination of the Age, Creatinine and Ejection Fraction (ACEF) Score and Fibrinogen Level in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Background: The purpose of this study was to explore whether consideration of FIB levels might improve the predictive value of the ACEF score in patients with ACS. Methods: A total of 290 patients with ACS were enrolled in this study. The clinical characteristics and MACE were recorded. Results: Multivariate logistic regression analysis revealed that the FIB level (odds ratio=7.798, 95%CI, 3.44–17.676, P&lt;0.001) and SYNTAX score (odds ratio=1.034, 95%CI, 1.001–1.069, P=0.041) were independent predictors of MACE. On the basis of the regression coefficient for FIB, the ACEF-FIB was developed. The area under the ROC of the ACEF-FIB scoring system in predicting MACE after PCI was 0.753 (95%CI 0.688–0.817, P&lt;0.001), a value greater than those for the ACEF score, SYNTAX score and Grace score (0.627, 0.637 and 0.570, respectively). Conclusion: ACEF-FIB had better discrimination ability than the other risk scores, according to ROC curve analysis, net reclassification improvement and integrated discrimination improvement.

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

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.

Predictive value of age, creatinine, and ejection fraction (ACEF) scoring system for operative mortality in patients with Stanford type A aortic dissection.

Stanford type A aortic dissection (TAAD) is the most common and fatal type of dissection. An easier-to-use risk stratification may help eliminate bias in patients at high risk of dissection. The age, serum creatinine, and ejection fraction (ACEF) score is a simple risk model developed to predict the mortality risk of elective coronary artery bypass graft surgery. This study aimed to evaluate the relationship between preoperative ACEF score and operative mortality in patients with TAAD undergoing emergency surgery. In this retrospective cohort study, 113 patients diagnosed with TAAD between January 2017 and September 2021 were evaluated. The primary endpoint was operative mortality. Receiver operating characteristic analysis was performed for the ACEF score, ACEF II score, and European System for Cardiac Operative Risk Evaluation II. Univariate and multivariate analyses of operative mortality were performed using the logistic regression model. Operative mortality occurred in 23 (20.4%) patients. The cutoff ACEF score was calculated as 1.1 for predicting operative mortality (area under the curve = 0.712, P value = 0.002, sensitivity = 74.0%, specificity = 67.8%, likelihood ratio = 2.3). Based on the cutoff value, 46 (40.7%) patients had a high ACEF score (ACEF ≥ 1.1) and 67 (59.3%) patients had a low ACEF score (ACEF < 1.1). The high ACEF score was associated with an increased incidence of operative mortality compared with the low ACEF score (37.0% vs. 9.0%; P = 0.001). The ACEF score can be used as a useful and relatively simple tool for risk stratification before TAAD surgery. However, the ACEF score is only indicated for risk assessment and should not affect treatment.

Predictive Value of the Age, Creatinine, and Ejection Fraction (ACEF) Score in Cardiovascular Disease among Middle-Aged Population.

To explore the predictive value of ACEF scores for identifying the risk of cardiovascular disease (CVD) in the general population. A total of 8613 participants without a history of CVD were enrolled in the follow-up. The endpoint was CVD incidence, defined as stroke or coronary heart disease (CHD) diagnosed during the follow-up period. Cox regression analyses were used to calculate hazard ratios (HRs) with respect to the age, creatinine, and ejection fraction (ACEF) scores and CVD. A Kaplan-Meier curve was used to analyze the probability of CVD in different quartiles of ACEF. Restricted cubic spline was used to further explore whether the relationship between ACEF and CVD was linear. Finally, we assessed the discriminatory ability of ACEF for CVD using C-statistics, net reclassification index, and integrated discrimination improvement (IDI). During a median follow-up period of 4.66 years, 388 participants were diagnosed with CVD. The Kaplan-Meier curve showed that ACEF was associated with CVD, and participants with high ACEF scores were significantly more likely to be diagnosed with CVD compared to participants with low ACEF scores in the general population. In the multivariate Cox regression analysis, the adjusted HRs for four quartiles of ACEF were as follows: the first quartile was used as a reference; the second quartile: HR = 2.33; the third quartile: HR = 4.81; the fourth quartile: HR = 8.00. Moreover, after adding ACEF to the original risk prediction model, we observed that new models had higher C-statistic values of CVD than the traditional model. Furthermore, the results of both NRI and IDI were positive, indicating that ACEF enhanced the prediction of CVD. Our study showed that the ACEF score was associated with CVD in the general population in northeastern China. Furthermore, ACEF could be a new tool for identifying patients at high risk of primary CVD in the general population.

Predictive value of ACEF score for clinical prognosis of patients with heavily calcified coronary lesions after percutaneous coronary intervention with rotational atherectomy

BackgroundTo inquiry the predictive value of the age, creatinine, and ejection fraction (ACEF) score for cardiac mortality in patients diagnosed with heavily calcified coronary lesions at 1 year after percutaneous coronary intervention (PCI) with rotational atherectomy (RA).Methods275 patients with heavily calcified coronary lesions undergoing PCI with RA in the Department of Cardiology of Anhui Provincial Hospital from January 2017 to December 2019 were consecutively recruited. The primary endpoint event was cardiac death at postoperative 1 year. The ROC curve was used to assess ACEF scoring system and predict cardiac mortality.ResultsIn term of ACEF score upon admission, 275 patients were divided into low-to-intermediate risk group (n = 130) with ACEF score < 1.23 and high-risk group (n = 145) with ACEF score ≥ 1.23. The age, gender proportion and left ventricular ejection fraction (LVEF) have a significant difference between the low-to-intermediate risk group and the high-risk group (all P < 0.05). The area under ROC curve for ACEF scoring system to predict cardiac mortality at 1 year after PCI with RA was 0.756 and 0.715, respectively.ConclusionsACEF value upon admission can predict the cardiac mortality at 1 year following PCI with RA in heavily calcified coronary lesions patients.

A simplified acute kidney injury predictor following endovascular aortic repair: ACEF score.

Treatment of abdominal aortic aneurysms (AAA) with endovascular aortic repair (EVAR) has become quite common in recent years. This method, which has many advantages compared to the open surgical procedure, also has some complications. One of these complications is acute kidney injury (AKI). ACEF (age, creatinine, and ejection fraction) score, which is gaining popularity, can be an easy-to-use and cost-effective method in detecting this condition that causes increased morbidity and mortality. We aimed to evaluate whether this ACEF score may predict a development of AKI in patients who underwent EVAR. A total of 133 consecutive patients with AAA who underwent EVAR were analyzed. The primary endpoint of the study was the development of AKI. The best cut-off value for the ACEF score to predict the development of AKI was calculated and according to this value, the patients were divided into two groups as those with high ACEF scores and those with low ACEF scores. ACEF score was calculated by the formula of age/EF + 1 (if baseline creatinine > 2mg/dL). After the exclusion criteria, a total of 118 patients were included in the study, and 20 (16.9%) of them developed AKI after EVAR. In the ROC curve analysis, a cut-off value of 1.34 was found for the ACEF score, and scores above this value were found to be independent predictors of AKI development after EVAR. In addition to the ACEF score, the contrast media volume was also found to be an independent predictor of the development of AKI. In conclusion, ACEF is a simple and effective scoring system in patients undergoing EVAR. To the best our knowledge, our study is the first study which applies ACEF score to predict AKI in EVAR patients.

A Novel Multiple Risk Score Model for Prediction of Long-Term Ischemic Risk in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: Insights From the I-LOVE-IT 2 Trial.

Backgrounds: A plug-and-play standardized algorithm to identify the ischemic risk in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) could play a valuable step to help a wide spectrum of clinic workers. This study intended to investigate the ability to use the accumulation of multiple clinical routine risk scores to predict long-term ischemic events in patients with CAD undergoing PCI.Methods: This was a secondary analysis of the I-LOVE-IT 2 (Evaluate Safety and Effectiveness of the Tivoli drug-eluting stent (DES) and the Firebird DES for Treatment of Coronary Revascularization) trial, which was a prospective, multicenter, and randomized study. The Global Registry for Acute Coronary Events (GRACE), baseline Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX), residual SYNTAX, and age, creatinine, and ejection fraction (ACEF) score were calculated in all patients. Risk stratification was based on the number of these four scores that met the established thresholds for the ischemic risk. The primary end point was ischemic events at 48 months, defined as the composite of cardiac death, nonfatal myocardial infarction, stroke, or definite/probable stent thrombosis (ST).Results: The 48-month ischemic events had a significant trend for higher event rates (from 6.61 to 16.93%) with an incremental number of risk scores presenting the higher ischemic risk from 0 to ≥3 (p trend < 0.001). In addition, the categories were associated with increased risk for all components of ischemic events, including cardiac death (from 1.36 to 3.15%), myocardial infarction (MI) (from 3.31 to 9.84%), stroke (3.31 to 6.10%), definite/probable ST (from 0.58 to 1.97%), and all-cause mortality (from 2.14 to 6.30%) (all p trend < 0.05). The net reclassification index after combined with four risk scores was 12.5% (5.3–20.0%), 9.4% (2.0–16.8%), 12.1% (4.5–19.7%), and 10.7% (3.3–18.1%), which offered statistically significant improvement in the performance, compared with SYNTAX, residual SYNTAX, ACEF, and GRACE score, respectively.Conclusion: The novel multiple risk score model was significantly associated with the risk of long-term ischemic events in these patients with an increment of scores. A meaningful improvement to predict adverse outcomes when multiple risk scores were applied to risk stratification.

Comparison of multiple risk scores in assessing medium-to long-term clinical outcomes in unstable angina / non-ST-elevation myocardial infarction patients undergoing multi vessel percutaneous coronary intervention: An observational, registry-based study in India

ObjectivePost-revascularization mortality in multivessel coronary artery disease (MVCAD) has been explored via several risk scores. Here, we assessed and compared various risk scores in predicting medium to long-term clinical outcomes in unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) patients with MVCAD undergoing percutaneous coronary intervention (PCI). MethodsWe analyzed a cohort of a tertiary care center registry enrolling patients in South India, Kerala, with MVCAD (N = 200) who had undergone PCI between 2010 and 2018. The outcomes evaluated were all-cause mortality and major adverse cardiac events (MACE). The risk scores assessed included SYNTAX score (SS), residual SYNTAX score (rSS), SYNTAX revascularization index (SRI), age, creatinine, and ejection fraction (ACEF) score, clinical SYNTAX score (cSS), and SYNTAX score II (SSII). ResultsOf the analyzed risk scores, SSII had the best predictive capability with the area under the curve (AUC) of 0.79 in c-statistics, followed by ACEF score and cSS with AUCs of 0.74 and 0.65, respectively for all-cause mortality (p < 0.01). Kaplan–Meier survival curves and multivariate analysis by Cox regression showed SSII with cut-offs of >35.15 and > 29.55 to be the only score associated with higher mortality and MACE, respectively. ConclusionsIn UA/NSTEMI patients with relatively less complex MVCAD treated by PCI, the SSII, ACEF and cSS risk scores could predict the outcomes better. The SSII showed the best predictive performance for all-cause mortality and MACE. Scores based on baseline and residual atherosclerotic burden (SS, rSS, and SRI) performed poorly in predicting the mortality and MACE.

Predictive value of creatine kinase MB for contrast-induced acute kidney injury among myocardial infarction patients

BackgroundPredictive value of creatine kinase MB (CK-MB) for contrast-induced acute kidney injury (CI-AKI) among myocardial infarction (MI) patients has rarely been reported. We aim to evaluate the predictive value of CK-MB for CI-AKI among MI patients.MethodsTotally, 1131 MI patients were included from the REduction of rIsk for Contrast-Induced Nephropathy (REICIN) study. The peak CK-MB before coronary angiography (CAG) was chosen. The study population was divided into two groups by log-transformed CK-MB cut-off point. The association between CK-MB and CI-AKI was tested by multivariable logistic regression. CK-MB was integrated with Age, creatinine and ejection fraction (ACEF) score and Mehran risk score (MRS) to evaluate the additive value of CK-MB. The integrated models were validated internally by the bootstrap method and externally by the PREdictive Value of COntrast voluMe to creatinine Clearance Ratio (PRECOMIN) study data set.ResultsOverall, 62(5.48%) patients developed CI-AKI, patients with CK-MB point > 4.7 displayed a higher incidence of CI-AKI than those without (11.9% vs. 4.0%, p < 0.001). CK-MB point > 4.7 was independently associated with CI-AKI (adjusted OR: 3.40, 95% CI: 1.93–5.98, p < 0.001). The additions of CK-MB to ACEF score, Mehran score A and Mehran score B resulted in increases in C-statistics, which ranged from 0.680 to 0.733 (p = 0.046), 0.694 to 0.727 (p = 0.091), 0.704 to 0.734 (p = 0.102), respectively. Internal validation also showed increases in C-statistics, and external validation performed well in discrimination and calibration.ConclusionsPreprocedural peak CK-MB was a predictor of CI-AKI among MI patients.

Predictive value of the age, creatinine, and ejection fraction score in patients with myocardial infarction with nonobstructive coronary arteries.

BackgroundLittle is known about risk stratification in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA). We investigated whether the age, creatinine, and ejection fraction (ACEF) score (age [years]/ejection fraction [%] + 1 [if creatinine >176 μmol/L]) might predict long‐term outcomes after MINOCA.HypothesisThe ACEF score enables accurate risk prediction in patients with MINOCA.MethodsA total of 1179 patients with MINOCA were enrolled and divided based on their ACEF score tertile levels. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all‐cause death, nonfatal MI, nonfatal stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan–Meier and Cox regression analyses were performed. Discrimination was defined as the area under the curve (AUC) using receiver operating characteristic analysis.ResultsDuring the median follow‐up of 41.7 months, patients with MINOCA with higher ACEF score tertiles had a significantly higher incidence of MACE (6.3%, 12.5%, and 23.8%, respectively; p < .001). The adjusted risk of MACE increased with the rising ACEF score tertiles (1st tertile as reference; 2nd tertile: HR 2.70, 95% CI: 1.38–5.29, p = .004; and 3rd tertile: HR 5.35, 95% CI: 2.72–10.51, p < .001). Moreover, an elevated ACEF score was closely associated with an increased risk of MACE overall (HR 4.23, 95% CI: 3.37–5.30, p < .001) and in subgroups (all p < .05). The ACEF score also yielded a good predictive value (AUC 0.79) for MACE.ConclusionElevated ACEF scores were strongly associated with a poor prognosis after MINOCA. This simple and valid risk score may facilitate risk stratification and decision making in the population with MINOCA.

Prediction of 5-Year Mortality in Patients with Chronic Coronary Syndrome Treated with Elective Percutaneous Coronary Intervention: Role of the ACEF Score.

We evaluated the predictive power of age, creatinine, and ejection fraction (ACEF) score on mortality at 5-year follow-up in a population of 471 patients with chronic coronary syndrome (CCS) treated with percutaneous coronary intervention (PCI). Patients in the ACEF-High tertile showed the highest incidence of death at 5 years (15.7% vs. 2.6% in ACEF-Low and 4.3% in ACEF-Mid; log rank p<0.001). The ACEF score could significantly discriminate between patients who died and those who were still alive at 5 years (AUC 0.741, 95% CI 0.654-0.828), and an ACEF score >1.32 was identified as the optimal cutoff point to predict 5-year mortality (sensitivity 74%, specificity 68%). An ACEF score >1.32 was an independent predictor of 5-year mortality (HR 5.77, 95% CI 2.70-12.31; p<0.001). Our study shows that the ACEF score can predict mortality at 5-year follow-up in patients with CCS treated with PCI.

The new classification method in ACEF score is more useful in patients with acute coronary syndrome without ST segment elevation

Goal In this study, it was investigated whether the age, creatinine, and ejection fraction (ACEF) score [age (years) / ejection fraction (%) +1 (if creatinine &gt;2 mg / dL)] could predict in-hospital mortality in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and its relationship with the Global Record of Acute Coronary Events (GRACE) risk score were investigated.Material and methods The study enrolled 658 NSTE-ACS patients from January 2016 to August 2020. The patients were divided into two groups according to the ACEF score with an optimum cut-off value of 1.283 who were divided into two groups according to the ACEF score: low ACEF (≤1.283, n:382) and high ACEF (&gt;1.283, n: 276). The primary outcome of the study was in-hospital all-cause mortality. The primary outcome of the study was in-hospital all-cause mortality. Statistically accuracy was defined with area under the curve by receiver-operating characteristic curve analysis.Results In total, 13 (4.71 %) patients had in-hospital mortality. The ACEF score was significantly higher in the group with higher mortality than in the group with low mortality (2.1±0.53 vs. 1.34±0.56 p=0.001). The ACEF score was positively correlated with GRACE risk score (r=0.188 p&lt;0.0001). In ROC curve analysis, the AUC of the ACEF score for predicting in-hospital mortality was 0.849 (95 % CI, 0.820 to 0.876; p&lt;0.0001); sensitivity, 92.3 %; specificity, 59.2 %, and the optimum cut-off value was &gt;1.283.Conclusion The ACEF score presented excellent discrimination in predicting in-hospital mortality. We obtained an easier and more useful result by dividing the ACEF score into two groups instead of three in NSTE-ACS patients. As a simple, useful, and easily applicable risk stratification in the evaluation of an emergency event such as the ACEF score, it can significantly contribute to the identification of patients at high risk.

Predictive Value of the Age, Creatinine, and Ejection Fraction (ACEF) Score in Patients With Acute Fulminant Myocarditis.

ObjectivePatients with acute fulminant myocarditis often have more adverse cardiovascular events and higher mortality. The purpose of this study was to evaluate the usefulness of age, creatinine, and left ventricular ejection fraction (ACEF score), in determining the risk that acute fulminant myocarditis will lead to serious cardiovascular events, death, and cardiac dysfunction.MethodsWe retrospectively reviewed the demographics, laboratory tests, medications, echocardiographic examinations, in-hospital clinical outcomes, major adverse cardiovascular events (MACE), and survival rate at 1 year in the medical records of 220 consecutive subjects suffering from acute fulminant myocarditis from January 2013 to June 2019.ResultsTwo hundred twenty patients were divided into a survivor group and a non-survivor group. This study found that patients in the non-survivor group were older, had higher heart rates, and had more serious injuries to multiple organ functions. A high ACEF score at admission was independently associated with an unfavorable prognosis, and it was a predictor of in-hospital mortality. The current analysis extends the predictive performance of the ACEF scores at 30 days by evaluating echocardiographic data as applied to survivors of fulminant myocarditis and cumulative rates of MACE at 1 year. The results indicated that patients with high ACEF scores had poor recovery of cardiac function, and higher rates of MACE, all-cause death, and heart failure at 1 year than the low-ACEF group.ConclusionThe ACEF score was identified as an effective predictor of poor in-hospital outcomes, worse cardiac recovery after 30 days, and higher rates of MACE, all-cause death, and heart failure at 1 year in patients who had acute fulminant myocarditis. These data suggest that its predictive accuracy means the ACEF score could be used to assess the prognosis of patients with acute fulminant myocarditis.

Predictive value of ACEF score for clinical prognosis of elderly patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention.

To investigate the predictive value of the age, creatinine, and ejection fraction (ACEF) score for cardiac death in patients aged ≥75 years diagnosed with acute ST-segment elevation myocardial infarction (STEMI) at 1 month and 1 year after emergency percutaneous coronary intervention (PCI). A total of 360 patients with STEMI undergoing emergency PCI in the Department of Cardiology of Anhui Provincial Hospital from January 2013 to April 2018 were consecutively recruited. The primary endpoint event was cardiac death at postoperative 1 month and 1 year. The ROC curve was utilized to evaluate ACEF scoring system and predict cardiac death rate. According to ACEF score upon admission, 360 patients were divided into low-to-intermediate risk group (n=80) with ACEF score of 0.99-1.27 (1.18±0.07) and high-risk group (n=280) with ACEF score of 1.28-4.14 (1.83±0.51). The age, left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), heart rate and the proportion of complete revascularization in the high-risk group were significantly higher than those in low-to-intermediate risk group (all P<0.05). The area under ROC curve for ACEF scoring system to predict cardiac death at 1 month and 1 year following PCI was 0.809 and 0.763, respectively. ACEF value upon admission can predict the cardiac death rate at 1 month and 1 year after emergency PCI in STEMI patients aged ≥75 years old.

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

IntroductionIn patients who have undergone interventional cardiac procedures, the risk of bleeding is higher than in patients who received conservative treatment due to multiple medications and comorbidities.AimThis study aimed to evaluate the usefulness of the age, creatinine and ejection fraction (ACEF) score for predicting bleeding events and to compare short- and long-term clinical outcomes according to the ACEF score in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) with bail-out tirofiban therapy (BOTT).Material and methodsA total of 2,543 patients were included and divided into three groups according to the following ACEF score tertiles: T1 (ACEFlow ≤ 1.033), T2 (1.033 < ACEFmid ≤ 1.371), and T3 (ACEFhigh > 1.371). The main outcomes measured were the incidence rates of relevant bleeding events and mortality within 30 days and 3 years after the procedure.ResultsA total of 73 (2.9%) patients had Bleeding Academic Research Consortium bleeding events of grades 3, 4 or 5 and 104 (4%) patients died in a 30-day period. The ACEF score was effective at predicting 30-day bleeding (area under the receiver operating characteristic curve (AUC): 0.658, 95% confidence interval (CI): 0.579–0.737; p < 0.001), 30-day mortality (AUC = 0.701, 95% CI: 0.649–0.753; p < 0.001) and 3-year mortality (AUC = 0.778, 95% CI: 0.748–0.807; p < 0.001) events. Considering the ACEF score tertiles, T3 patients presented greater 30-day bleeding (1.6%, 2.8% and 4.1%; odds ratio (OR) = 2.56, 95% CI: 1.37–4.80), 30-day mortality (1.7%, 3.5% and 7.1%; OR = 4.53, 95% CI: 2.51–8.18) and 3-year mortality (6.4%, 11% and 19.8%; hazard ratio = 3.56, 95% CI: 2.58–4.91) risks.ConclusionsThe ACEF score is a user-friendly tool with excellent predictive value for bleeding events and mortality in patients undergoing pPCI with BOTT.

Correlation between serum free triiodothyronine levels and risk stratification in Chinese patients with acute coronary syndrome receiving percutaneous coronary intervention.

ObjectiveLow serum free triiodothyronine (FT3) levels are associated with the occurrence of coronary heart disease and with the prognosis of cardiovascular diseases. This study aimed to investigate the relationship between FT3 levels and risk stratification in Chinese Han patients with acute coronary syndrome (ACS) receiving percutaneous coronary intervention (PCI) treatment.MethodsPlasma FT3 levels and other parameters were measured in 191 patients with ACS who received PCI. The risk of adverse cardiovascular events was assessed using the Age, Creatinine, and Ejection Fraction (ACEF) score.ResultsFT3 levels were significantly lower in the high-risk group than in the medium- and low-risk groups. Serum FT3 levels were negatively linearly correlated with the ACEF score (r = −0.590). Stepwise regression analysis showed a negative correlation between FT3 levels and the risk of adverse cardiovascular events as measured by the ACEF score (standardized β = −0.261).ConclusionSerum FT3 levels are negatively related to risk stratification in patients with ACS. Serum FT3 levels may be used as a potential predictor for adverse outcomes of patients with ACS undergoing PCI.