Prognostic Value of the Age, Creatinine, and Ejection Fraction Score for 1-Year Mortality in 30-Day Survivors Who Underwent Percutaneous Coronary Intervention After Acute Myocardial Infarction

• Published in: The American journal of cardiology Vol. 115; no. 9; pp. 1167 - 1173
• Main Authors: Lee, Jang Hoon, MD, Bae, Myung Hwan, MD, Yang, Dong Heon, MD, Park, Hun Sik, MD, Cho, Yongkeun, MD, Jeong, Myung Ho, MD, Kim, Young Jo, MD, Kim, Kee-Sik, MD, Hur, Seung Ho, MD, Seong, In Whan, MD, Cho, Myeong Chan, MD, Kim, Chong Jin, MD, Chae, Shung Chull, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2015; Elsevier Limited
• Subjects: Age Factors; Aged; Area Under Curve; Cardiology; Cardiovascular; Cardiovascular disease; Creatinine - blood; Drug therapy; Female; Heart attacks; Humans; Male; Middle Aged; Mortality; Myocardial Infarction - blood; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - surgery; Percutaneous Coronary Intervention; Predictive Value of Tests; Prognosis; Registries; Republic of Korea; Risk Factors; ROC Curve; Stroke Volume; Survival Rate; Survivors; Time Factors; Republic of Korea
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2015.02.001

Few simple and effective tools are available for determining the prognosis of 30-day survivors after acute myocardial infarction. We aimed to assess whether the simple age, creatinine, and ejection fraction (ACEF) score could predict 1-year mortality of 12,000 post–myocardial infarction 30-day survivors who underwent percutaneous coronary intervention. The ACEF score was computed as follows: (age/ejection fraction) + 1, if the serum creatinine was >2 mg/dl. Accuracy was defined through receiver-operating characteristics analysis and area under the curve (AUC) evaluation. Twelve risk factors were selected and ranked according to their AUC value. Age, ejection fraction, and serum creatinine levels indicated the best AUC value. The ACEF score was significantly higher in the nonsurvivors (1.95 ± 0.82 vs 1.28 ± 0.50; p <0.001) and was an independent predictor of 1-year mortality (adjusted hazard ratio 2.26; p <0.001). The best accuracy was achieved by a prediction model including 12 risk factors (AUC = 0.80), but this did not significantly differ compared with the AUC (0.79) of the ACEF score (p = ns). Adjusted hazard ratios for 1-year mortality were 1 (reference), 3.11 (p <0.001), and 10.38 (p <0.001) for the ACEFLOW (ACEF score <1.0), ACEFMID (ACEF score 1.0 to 1.39), and ACEFHIGH (ACEF score ≥1.4) groups, respectively. The ACEF score may be a novel valid model to stratify the 1-year mortality risk in 30-day survivors who underwent percutaneous coronary intervention after acute myocardial infarction.