简化经皮冠状动脉介入治疗分叉病变的临床风险预测：ACEF（年龄、肌酐、射血分数）评分的作用。
Simplifying clinical risk prediction for percutaneous coronary intervention of bifurcation lesions: the case for the ACEF (age, creatinine, ejection fraction) score.
机构信息
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina, Italy.
出版信息
EuroIntervention. 2012 Jul 20;8(3):359-67. doi: 10.4244/EIJV8I3A55.
AIMS
We aimed to appraise the predictive accuracy of a novel and user-friendly risk score, the ACEF (age, creatinine, ejection fraction), in patients undergoing PCI for coronary bifurcations.
METHODS AND RESULTS
A multicentre, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between January 2002 and December 2006 in 22 Italian centres. Patients with complete data to enable computation of the ACEF score were divided into three groups according to tertiles of ACEF score. The primary endpoint was 30-day mortality. The discrimination of the ACEF score as a continuous variable was also appraised with area under the curve (AUC) of the receiver-operating characteristic. A total of 3,535 patients were included: 1,119 in the lowest tertile of ACEF score, 1,190 in the mid tertile, and 1,153 in the highest tertile. Increased ACEF score was associated with significantly different rates of 30-day mortality (0.1% in the lowest tertile vs. 0.5% in the mid tertile and 3.0% in the highest tertile, p<0.001), with similar differences in myocardial infarction (0.3% vs. 0.7% and 1.8%, p<0.001) and major adverse cardiac events (MACE, 0.5% vs. 1.2% and 4.3%, p<0.001). After an average follow-up of 24.4±15.1 months, increased ACEF score was still associated with a higher rate of all-cause death (1.3% vs. 2.4% and 11.0%, p<0.001), cardiac death (0.9% vs. 1.4% and 7.2%, p<0.001), myocardial infarction (3.4% vs. 2.7% and 5.7%, p<0.001), MACE (13.6% vs. 15.9% and 22.3%, p<0.001), and stent thrombosis (2.3% vs. 1.8% and 5.0%, p<0.001). Discrimination of ACEF score was satisfactory for 30-day mortality (AUC=0.82 [0.77-0.87], p<0.001), 30-day MACE (AUC=0.73 [0.67-0.78], p<0.001), long-term mortality (AUC=0.77 [0.74-0.81], p<0.001), and moderate for long-term MACE (AUC=0.60 [0.57-0.62], p<0.001).
CONCLUSIONS
The simple and extremely user-friendly ACEF score can accurately identify patients undergoing PCI for coronary bifurcation lesions at high risk of early fatal or non-fatal complications, as well as long-term fatality.
目的
我们旨在评估一种新颖且易于使用的风险评分（ACEF，年龄、肌酐、射血分数）在接受冠状动脉分叉病变经皮冠状动脉介入治疗（PCI）的患者中的预测准确性。
方法和结果
本研究为多中心回顾性研究，纳入了 2002 年 1 月至 2006 年 12 月期间在意大利 22 个中心接受分叉 PCI 的连续患者。根据 ACEF 评分的三分位数，将具有计算 ACEF 评分完整数据的患者分为三组。主要终点为 30 天死亡率。还通过接受者操作特征曲线（ROC）的曲线下面积（AUC）评估 ACEF 评分作为连续变量的区分度。共纳入 3535 例患者：ACEF 评分最低三分位数 1119 例，中三分位数 1190 例，最高三分位数 1153 例。ACEF 评分升高与 30 天死亡率显著相关（最低三分位数为 0.1%，中三分位数为 0.5%，最高三分位数为 3.0%，p<0.001），心肌梗死（0.3% vs. 0.7% 和 1.8%，p<0.001）和主要不良心脏事件（MACE，0.5% vs. 1.2% 和 4.3%，p<0.001）也有类似差异。在平均 24.4±15.1 个月的随访后，ACEF 评分升高仍与全因死亡（1.3% vs. 2.4% 和 11.0%，p<0.001）、心脏死亡（0.9% vs. 1.4% 和 7.2%，p<0.001）、心肌梗死（3.4% vs. 2.7% 和 5.7%，p<0.001）、MACE（13.6% vs. 15.9% 和 22.3%，p<0.001）和支架血栓形成（2.3% vs. 1.8% 和 5.0%，p<0.001）的发生率升高相关。ACEF 评分对 30 天死亡率（AUC=0.82 [0.77-0.87]，p<0.001）、30 天 MACE（AUC=0.73 [0.67-0.78]，p<0.001）、长期死亡率（AUC=0.77 [0.74-0.81]，p<0.001）和中度长期 MACE（AUC=0.60 [0.57-0.62]，p<0.001）的区分度均令人满意。
结论
简单且非常易于使用的 ACEF 评分可以准确识别接受冠状动脉分叉病变 PCI 治疗的患者，这些患者存在早期致命或非致命并发症以及长期死亡的高风险。
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