ACEF performed better than other risk scores in non-ST-elevation acute coronary syndrome during long term follow-up
Ivica Kristić1, Nikola Crnčević1, Frane Runjić1
1Department of Cardiology, University Hospital of Split, Split, Croatia.
Insights
The ACEF score demonstrated superior risk stratification for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) undergoing all-treatment strategies. This user-friendly tool aids in predicting Major Adverse Cardiovascular Events (MACE) during long-term follow-up.
Area of Science:
- Cardiology
- Clinical Risk Assessment
- Acute Coronary Syndromes
Background:
- Risk stratification is crucial for non-ST-elevation acute coronary syndrome (NSTE-ACS) patients.
- Long-term studies evaluating risk scores in all-treatment NSTE-ACS cohorts are limited.
- This study compares established risk scores in such a cohort.
Purpose of the Study:
- To compare the performance of six established risk scores.
- To assess risk stratification accuracy for Major Adverse Cardiovascular Events (MACE).
- To evaluate risk scores in NSTE-ACS patients undergoing comprehensive treatment strategies over the long term.
Main Methods:
- Recruited 276 NSTE-ACS patients undergoing coronary angiography (Sept 2012 - May 2015).
- Calculated GRACE 2.0, ACEF, SYNTAX, Clinical SYNTAX, SYNTAX II PCI, and SYNTAX II CABG scores.
- Primary endpoint was MACE (cardiac death, MI, stroke, urgent revascularization) over median 33-month follow-up.
Main Results:
- 64 MACE outcomes (23.2%) occurred during follow-up.
- ACEF and SYNTAX II PCI scores' highest risk groups showed significantly more MACE.
- Multivariate analysis identified age and atrial fibrillation as predictors; only ACEF score significantly predicted MACE.
- ACEF (0.630) and SYNTAX II PCI (0.626) had the best AUC values for MACE prediction.
Conclusions:
- The ACEF risk score demonstrated superior discrimination compared to other scores.
- ACEF is a potentially fast and user-friendly tool for stratifying NSTE-ACS patients.
- Findings support ACEF score's utility in long-term risk assessment for NSTE-ACS patients under all-treatment strategies.
Background:
Risk stratification of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) is an important clinical method, but long-term studies on patients subjected to all-treatment strategies are lacking. Therefore, the aim was to compare several established risk scores in the all-treatment NSTE-ACS cohort during long-term follow-up.
Methods:
Consecutive patients (n = 276) with NSTE-ACS undergoing coronary angiography were recruited between September 2012 and May 2015. Six risk scores for all patients were calculated, namely GRACE 2.0, ACEF, SYNTAX, Clinical SYNTAX, SYNTAX II PCI and SYNTAX II CABG. The primary end-point was Major Adverse Cardiovascular Events (MACE) which was a composite of cardiac death, nonfatal myocardial infarction, ischemic stroke or urgent coronary revascularization.
Results:
During a median follow-up of 33 months, 64 MACE outcomes were recorded (23.2%). There was no difference between risk score categories, except in the highest risk group of ACEF and SYNTAX II PCI scores which exhibited significantly more MACE (51.6%, N = 33 and 45.3%, N = 29, P = 0.024, respectively). In the multivariate Cox regression analysis of individual variables, only age and atrial fibrillation were significant predictors for MACE (HR 1.03, 95% CI 1.00-1.05, P = 0.023 and HR 2.02, 95% CI 1.04-3.89, P = 0.037, respectively). Furthermore, multivariate analysis of the risk scores showed significant prediction of MACE only with ACEF score (HR 2.16, 95% CI 1.36-3.44, P = 0.001). The overall performance of GRACE, SYNTAX, Clinical SYNTAX and SYNTAX II CABG was poor with AUC values of 0.596, 0.507, 0.530 and 0.582, respectively, while ACEF and SYNTAX II PCI showed the best absolute AUC values for MACE (0.630 and 0.626, respectively).
Conclusions:
ACEF risk score showed better discrimination than other risk scores in NSTE-ACS patients undergoing all-treatment strategies over long-term follow-up and it could represent a fast and user-friendly tool to stratify NSTE-ACS patients.
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