title: Simplifying clinical risk prediction for percutaneous coronary intervention of bifurcation lesions: the case for the ACEF (age, creatinine, ejection fraction) score.
abstract: OBJECTIVE
  We aimed to appraise the predictive accuracy of a novel and user-friendly risk score, the ACEF (age, creatinine, ejection fraction), in patients undergoing PCI for coronary bifurcations.
  
  
  RESULTS
  A multicentre, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and December 2006 in 22 Italian centres. Patients with complete data to enable computation of the ACEF score were divided into three groups according to tertiles of ACEF score. The primary endpoint was 30-day mortality. The discrimination of the ACEF score as a continuous variable was also appraised with area under the curve (AUC) of the receiver-operating characteristic. A total of 3,535 patients were included: 1,119 in the lowest tertile of ACEF score, 1,190 in the mid tertile, and 1,153 in the highest tertile. Increased ACEF score was associated with significantly different rates of 30-day mortality (0.1% in the lowest tertile vs. 0.5% in the mid tertile and 3.0% in the highest tertile, p<0.001), with similar differences in myocardial infarction (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). After an average follow-up of 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), myocardial infarction (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). Discrimination of ACEF score was satisfactory for 30-day mortality (AUC=0.82 [0.77-0.87], p<0.001), 30-day MACE (AUC=0.73 [0.67-0.78], p<0.001), long-term mortality (AUC=0.77 [0.74-0.81], p<0.001), and moderate for long-term MACE (AUC=0.60 [0.57-0.62], p<0.001).
  
  
  CONCLUSIONS
  The simple and extremely 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.
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina, Italy. gbiondizoccai@gmail.com
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Enrico
authors.initials: E
authors.lastname: Romagnoli
authors.forename: Davide
authors.initials: D
authors.lastname: Castagno
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bolognese
authors.forename: Leonardo
authors.initials: L
authors.lastname: Paloscia
authors.forename: Paolo
authors.initials: P
authors.lastname: Rubino
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sardella
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.forename: Luigi
authors.initials: L
authors.lastname: Niccoli
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Franco
authors.forename: Domenico
authors.initials: D
authors.lastname: Di Girolamo
authors.forename: Luigi
authors.initials: L
authors.lastname: Piatti
authors.forename: Cesare
authors.initials: C
authors.lastname: Greco
authors.forename: A Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Bruno
authors.initials: B
authors.lastname: Loi
authors.forename: Alberto
authors.initials: A
authors.lastname: Benassi
authors.forename: Aldo
authors.initials: A
authors.lastname: Patti
authors.forename: Achille
authors.initials: A
authors.lastname: Gaspardone
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sangiorgi
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000628:therapy*; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume
chemical_list: D003404:Creatinine