IRCCS Policlinico San Donato, Milan, Italy.
J Thorac Cardiovasc Surg. 2011 Sep;142(3):581-6. doi: 10.1016/j.jtcvs.2010.11.064. Epub 2011 Jun 24.
Age, preoperative creatinine value, and ejection fraction are easily arranged in the age, creatinine, ejection fraction score to predict operative mortality in elective cardiac operations, as recently shown. We validate the age, creatinine, ejection fraction score in a large multicentric study.
We analyzed 29,659 consecutive patients who underwent elective cardiac operations in 14 Italian institutions during the period from 2004 to 2009. The operative (30-day) mortality rate was recorded for the entire population and for subgroups of patients based on the risk distribution. The predicted mortality was assessed using the additive and logistic European System for Cardiac Operative Risk Evaluations, and the age, creatinine, ejection fraction score. Accuracy and clinical performance of the different models were tested.
The observed mortality rate was 2.77% (95% confidence interval, 2.59-2.96). The predicted mortality rate was 2.84% (95% confidence interval, 2.79-2.88) for the age, creatinine, ejection fraction score (not significantly different from the observed rate), 6.26% for the additive European System for Cardiac Operative Risk Evaluation, and 9.67% for the logistic European System for Cardiac Operative Risk Evaluation (both significantly overestimated). For all deciles of risk distribution, the European System for Cardiac Operative Risk Evaluation significantly overestimated mortality risk; the age, creatinine, ejection fraction score slightly overestimated the mortality risk in very low-risk patients and significantly underestimated the mortality risk in very high-risk patients, correctly estimating the risk in 7 of 10 deciles. The accuracy of the age, creatinine, ejection fraction score was acceptable (area under the curve of 0.702). In a separate analysis, this value increased to 0.74 by excluding centers that reported no operative mortality. These values were similar or worse for the European System for Cardiac Operative Risk Evaluation.
The age, creatinine, ejection fraction score provides an accuracy level comparable to that of the European System for Cardiac Operative Risk Evaluation, with far superior clinical performance.
最近有研究表明，年龄、术前肌酐值和射血分数可通过年龄、肌酐、射血分数评分（age, creatinine, ejection fraction score，ACEF 评分）轻松排列，预测择期心脏手术的手术死亡率。本研究旨在通过一项大型多中心研究验证 ACEF 评分。
我们分析了 2004 年至 2009 年期间，14 家意大利机构进行的 29659 例连续择期心脏手术患者的资料。记录了全人群以及根据风险分布分组的患者的手术（30 天）死亡率。使用附加的和逻辑的欧洲心脏手术风险评估系统（European System for Cardiac Operative Risk Evaluations，EuroSCORE）以及 ACEF 评分评估预测死亡率。检验了不同模型的准确性和临床性能。
观察到的死亡率为 2.77%（95%置信区间，2.59-2.96）。ACEF 评分的预测死亡率为 2.84%（95%置信区间，2.79-2.88）（与观察到的死亡率无显著差异），附加 EuroSCORE 为 6.26%，逻辑 EuroSCORE 为 9.67%（均显著高估）。在所有风险分布十分位数中，EuroSCORE 显著高估了死亡率风险；ACEF 评分在低危患者中略高估了死亡率风险，在高危患者中显著低估了死亡率风险，在 10 个十分位数中的 7 个正确估计了风险。ACEF 评分的准确性可接受（曲线下面积为 0.702）。在单独分析中，排除报告无手术死亡率的中心后，该值增加到 0.74。对于 EuroSCORE，这些值相似或更差。
ACEF 评分提供了与 EuroSCORE 相当的准确性水平，具有优越得多的临床性能。
