Value of Age, Creatinine, and Ejection Fraction (ACEF Score) in Assessing Risk in Patients Undergoing Percutaneous Coronary Interventions in the ‘All-Comers' LEADERS Trial

Abstract

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: ACEF low ≤1.0225, 1.0225< ACEF mid ≤1.277, and ACEF high >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 (ACEF low =92.1%, ACEF mid =89.5%, and ACEF high =86.1%; P =0.0218). Cardiac death was less frequent in ACEF low than in ACEF mid and ACEF high (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 ACEF high vs 5.2% for ACEF mid and 2.5% for ACEF low ; hazard ratio=1.6, P =0.006). Clinically driven target-vessel revascularization also tended to be higher in the ACEF high group, 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 ACEF high group (ACEF low =1.2%, ACEF mid =3.5%, and ACEF high =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. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00389220.