The ACEF (age, creatinine, ejection fraction) score predicts ischemic and bleeding outcomes of patients with acute coronary syndromes treated conservatively

Introduction

Assessment of both ischemic and bleeding risk is crucial for the management of patients with coronary artery disease, especially patients with acute coronary syndromes (ACS) [1, 2]. At present, the use of the Global Registry for Acute Coronary Events (GRACE) risk score is recommended in patients presenting with non-ST-segment elevation ACS as it provides the most accurate stratification of risk both on admission and at discharge. However, there is growing interest in a more simplified approach to risk stratification [1, 3, 4]. Ranucci et al. introduced the Age, Creatinine and Ejection Fraction (ACEF) score, a simple, three-variable model for predicting mortality in patients undergoing elective cardiac surgery [5]. More importantly, the predictive value of the ACEF score was confirmed in different subsets of patients undergoing percutaneous coronary interventions (PCI) and transcatheter aortic valve implantation (TAVI) [6–10]. The ACEF score was associated with satisfactory predictive value not only in terms of short- and long-term mortality but also in terms of major adverse cardiovascular events, myocardial infarction, target lesion revascularization, stent thrombosis and acute kidney injury after PCI [7, 8, 10, 11]. However, the ability of the ACEF score to predict other in-hospital outcomes, including bleeding events in patients with ACS, is less established.

Aim

Thus, we aimed to assess the value of the ACEF score in prediction of death as well as other in-hospital outcomes in patients presenting with ACS in hospitals without on-site invasive facilities.

Material and methods

The Krakow Registry of Acute Coronary Syndromes was a prospective, multicenter, observational registry designed to examine in-hospital management and outcome of patients with ACS admitted to 29 community hospitals without on-site invasive facilities in this region of Poland [12–14]. Data were collected during two separate enrollment periods: from February 2005 to March 2005 and from December 2005 to January 2006, and to minimize selection bias all consecutive patients with a suspected diagnosis of ACS were included regardless of the treatment strategy or outcome. Data concerning baseline demographic and clinical characteristics, relevant laboratory results, pharmacotherapy during hospital stay and adverse cardiovascular outcomes were recorded on a standardized, electronic, web-page based case report form. Standardized definitions...


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