医学
狼牙棒
内科学
心肌梗塞
心脏病学
经皮冠状动脉介入治疗
传统PCI
射血分数
心力衰竭
冠状动脉疾病
作者
Martin Reindl,Sebastian J. Reinstadler,Christina Tiller,Markus Kofler,Markus Theurl,Nora Klier,K. Fleischmann,Agnes Mayr,Benjamin Henninger,Gert Klug,Bernhard Metzler
标识
DOI:10.1016/j.ijcard.2018.04.017
摘要
Background The age, creatinine and ejection fraction (ACEF) score has originally been developed for risk stratification of patients undergoing elective cardiac surgery. In patients with stable coronary artery disease treated by percutaneous coronary intervention (PCI), the prognostic accuracy of ACEF could be further improved by modifying the original scoring system (called "modified ACEF" or "ACEF-MDRD"). We aimed to specifically adapt the ACEF score for risk assessment of ST-elevation myocardial infarction (STEMI) patients. Methods In this observational study, 390 STEMI patients undergoing primary PCI were included. Clinical endpoint was the occurrence of major adverse cardiovascular events (MACE) comprising all-cause mortality, non-fatal re-infarction, stroke and new congestive heart failure. Results Original ACEF (area under the curve (AUC):0.63 [95%CI:0.53–0.73]; p = 0.01) and ACEF-MDRD score (AUC:0.62 [95%CI:0.53–0.72]; p = 0.01) significantly but weakly predicted MACE (n = 41, 11%). The addition of creatinine > 2 mg/dl (as suggested in original ACEF, p = 0.32) or eGFR steps as proposed in ACEF-MDRD (p = 0.17) to age/EF ratio were not associated with net reclassification improvements (NRI), but ΔeGRF (>10 ml/min/1.73 m2 decrease within three days after PCI) led to an NRI of 0.29 (95%CI:0.14–0.45; p < 0.001). Replacement of cross-sectional renal assessment by ΔeGRF and addition of 3 clinical parameters (diabetes, anterior infarct location and C-reactive protein), forming the new ACEF-STEMI score, led to a significant improvement in MACE prediction (AUC:0.75 [95%CI:0.66–0.84]) as compared to original ACEF or ACEF-MDRD (both p = 0.03). Conclusions In STEMI patients undergoing primary PCI, the novel ACEF-STEMI score provided strong prognostic value and superior discriminative ability as compared to the previously described original ACEF or ACEF-MDRD scores.
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