title: 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.
  
  
  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.
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, 's Gravendijkwal 230, Rotterdam, Netherlands.
authors.forename: Joanna J
authors.initials: JJ
authors.lastname: Wykrzykowska
authors.forename: Scot
authors.initials: S
authors.lastname: Garg
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.forename: Ton
authors.initials: T
authors.lastname: de Vries
authors.forename: Dick
authors.initials: D
authors.lastname: Goedhart
authors.forename: Marie-Angele
authors.initials: MA
authors.lastname: Morel
authors.forename: Gerrit-Anne
authors.initials: GA
authors.lastname: van Es
authors.forename: Pawel
authors.initials: P
authors.lastname: Buszman
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.forename: Thomas
authors.initials: T
authors.lastname: Ischinger
authors.forename: Volker
authors.initials: V
authors.lastname: Klauss
authors.forename: Roberto
authors.initials: R
authors.lastname: Corti
authors.forename: Franz
authors.initials: F
authors.lastname: Eberli
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: Carlo
authors.initials: C
authors.lastname: di Mario
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Peter
authors.initials: P
authors.lastname: Juni
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality*; D003324:Coronary Artery Disease / Q000097:blood / Q000628:therapy*; D003404:Creatinine / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D013318:Stroke Volume
chemical_list: D003404:Creatinine