Giuseppe biondi zoccai md university of modena and reggio emilia gbiondizoccai@gmail com
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Improving clinical risk prediction for percutaneous coronary intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score. Giuseppe Biondi Zoccai, MD University of Modena and Reggio Emilia [email protected] BACKGROUND.

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Giuseppe biondi zoccai md university of modena and reggio emilia gbiondizoccai@gmail com

Improving clinical risk prediction for percutaneous coronary intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score

Giuseppe Biondi Zoccai, MD

University of Modena and Reggio Emilia

[email protected]


Background
BACKGROUND intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score

  • Coronary bifurcations are among the most challenging lesions for percutaneous coronary intervention (PCI).

  • There is no simple and effective tool to identify patients with a good prognosis despite such complex coronary disease.

  • A novel and user-friendly risk score, the ACEF (age, creatinine, ejection fraction) has been proved effective in unselected patients undergoing cardiac surgery.

  • However, limited data are available in patients undergoing PCI.


GOAL intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score

  • We aimed to appraise the predictive accuracy of the ACEF in patients undergoing PCI for coronary bifurcations.


Methods
METHODS intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score

  • A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and December 2006 in 22 Italian centers.

  • Patients with complete data to enable computation of the ACEF score (defined as age [years]/ejection fraction [%]+1 [if serum creatinine value was >2.0 mg/dL) were divided in 3 groups according to tertiles of ACEF score.


Methods1
METHODS intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score

  • The primary end-point was the long-term rate of all cause mortality.

  • Additional end-points including early and long-term rates of all cause death, cardiac death, myocardial infarction (MI), major adverse cardiac events (MACE, i.e. Death, MI or revascularization), and stent thrombosis.

  • The discrimination of the ACEF score as a continuous variable was also appraised with area under the curve (AUC) of the receiver-operating characteristic.


Results
RESULTS intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score

  • A total of 3,535 patients were included: 1119 in the lowest quartile of ACEF score, 1190 in the 2nd quartile, and 1153 in the highest quartile.

  • Increased ACEF score was associated with significantly different rates of early all cause death (0.1% in the 1st quartile vs 0.5% in the 2nd quartile and 3.0% in the 3rd quartile, p<0.001), with similar differences in MI (0.3% vs 0.7% and 1.8%, p<0.001) and major adverse cardiac events (MACE, 0.5% vs 1.2% and 4.3%, p<0.001).


Results1
RESULTS intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score

  • After 24.4±15.1 months, increased ACEF score was still associated with a higher rate of all cause death (1.3% vs 2.4% and 11.0%, p<0.001), cardiac death (0.9% vs 1.4% and 7.2%, p<0.001), MI (3.4% vs 2.7% and 5.7%, p<0.001), MACE (13.6% vs 15.9% and 22.3%, p<0.001), and stent thrombosis (2.3% vs 1.8% and 5.0%, p<0.001).


Results2
RESULTS intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score

  • Discrimination of ACEF score was good for early all cause death (AUC=0.82 [0.77-0.87]), early MACE (AUC=0.73 [0.67-0.78]), long-term all cause death (AUC=0.76 [0.72-0.79]) and long-term cardiac death (AUC=0.76 [0.72-0.81]).

  • Conversely, it appeared modest for long-term MACE (AUC=0.58 [0.55-0.60]).


Baseline features
BASELINE FEATURES intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score


Lesion procedural data
LESION/PROCEDURAL DATA intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score


Early outcomes
EARLY OUTCOMES intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score


Long term outcomes
LONG-TERM OUTCOMES intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score


Early death
EARLY DEATH intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score

Area under the curve=0.82 (0.77-0.87), p<0.001


Early mace
EARLY MACE intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score

Area under the curve=0.73 (0.67-0.78), p<0.001


Long term death
LONG TERM DEATH intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score

Area under the curve=0.79 (0.72-0.79), p<0.001


Long term cardiac death
LONG TERM CARDIAC DEATH intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score

Area under the curve=0.76 (0.72-0.81), p<0.001


Long term mace
LONG TERM MACE intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score

Area under the curve=0.58 (0.55-0.60), p<0.001


Conclusions
CONCLUSIONS intervention for bifurcation lesions: the ACEF (age, creatinine, ejection fraction) score

  • The simple and user-friendly ACEF score can accurately identify patients undergoing PCI for coronary bifurcation lesions at high risk of early fatal or non-fatal complications, as well as long-term fatality.

  • Its role in comparison to more complex and sophisticated predictions tools (e.g. the SYNTAX score) warrants further investigations.


For these and further slides on these topics please feel free to visit the metcardio.org website:http://www.metcardio.org/slides.html


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