ACEF score adapted to ST-elevation myocardial infarction patients: The ACEF-STEMI score

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.

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.

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).

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.