Background-The age, creatinine, and ejection fraction (ACEF) score (age/left ventricular ejection fraction+1 if creatinine >2.0 mg/dL) has been established as an effective predictor of clinical outcomes in patients undergoing elective coronary artery bypass surgery; however, its utility in "all-comer" patients undergoing percutaneous coronary intervention is yet unexplored. Methods and Results-The ACEF score was calculated for 1208 of the 1707 patients enrolled in the LEADERS trial. Post hoc analysis was performed by stratifying clinical outcomes at the 1-year follow-up according to ACEF score tertiles: ACEFlow≤1.0225, 1.0225< ACEFmid≤1.277, and ACEFhigh>1.277. At 1-year follow-up, there was a significantly lower number of patients with major adverse cardiac event-free survival in the highest tertile of the ACEF score (ACEFlow=92.1%, ACEFmid=89.5%, and ACEFhigh=86.1%; P=0.0218). Cardiac death was less frequent in ACEFlowthan in ACEFmidand ACEFhigh(0.7% vs 2.2% vs 4.5%; hazard ratio=2.22, P=0.002) patients. Rates of myocardial infarction were significantly higher in patients with a high ACEF score (6.7% for ACEFhighvs 5.2% for ACEFmidand 2.5% for ACEFlow; hazard ratio=1.6, P=0.006). Clinically driven target-vessel revascularization also tended to be higher in the ACEFhighgroup, but the difference among the 3 groups did not reach statistical significance. The rate of composite definite, possible, and probable stent thrombosis was also higher in the ACEFhighgroup (ACEFlow=1.2%, ACEFmid=3.5%, and ACEFhigh=6.2%; hazard ratio=2.04, P=0.001). Conclusions-ACEF score may be a simple way to stratify risk of events in patients treated with percutaneous coronary intervention with respect to mortality and risk of myocardial infarction.

Additional Metadata
Keywords ACEF score, Biodegradable polymer, Biolimus-eluting stent, Cardiac death, Major adverse cardiac event, Sirolimus-eluting stent, Syntax score
Persistent URL dx.doi.org/10.1161/CIRCINTERVENTIONS.110.958389, hdl.handle.net/1765/34687
Citation
Wykrzykowska, J.J., Garg, S.A., Onuma, Y., de Vries, A., Goedhart, D., Morel, M-A.M., … Serruys, P.W.J.C.. (2011). Value of age, creatinine, and ejection fraction (acef score) in assessing risk in patients undergoing percutaneous coronary interventions in the 'All-Comers' LEADERS Trial. Circulation. Cardiovascular Interventions, 4(1), 47–56. doi:10.1161/CIRCINTERVENTIONS.110.958389