Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Catheter Cardiovasc Interv. 2020 Feb;95 Suppl 1:534-541. doi: 10.1002/ccd.28673. Epub 2019 Dec 26.
To improve the prognostic value of the age, creatinine, and ejection fraction (ACEF) score following percutaneous coronary intervention (PCI) by integrating the residual SYNTAX score (rSS).
ACEF score was proposed for predicting the operative mortality risk in elective cardiac operations and has been validated in numerous studies. However, it does not incorporate coronary lesion-based variables for risk assessment of patients who undergo PCI.
Overall, 10,072 patients who underwent PCI at our hospital in 2013 were enrolled. The endpoint was 2-year cardiac death after PCI, defined as death that was not attributed to a non-cardiac cause. ACEF-rSS was constructed with incremental weights attributed to the ACEF score and rSS according to their estimated coefficients.
2-year cardiac death occurred in 63 patients (0.63%). In multivariable analyses, the ACEF score and rSS > 8 were independently associated with the risk of cardiac death. ACEF-rSS was computed as age (years)/ejection fraction (%) + 1 (if creatinine ≥2.0 mg/dl) + 1 (if rSS >8). The discrimination of ACEF-rSS was significantly better than that of the ACEF score based on receiver operating characteristic (ROC) curve analysis and integrated discrimination improvement (IDI) (C-statistics = 0.835 vs. 0.776 for ACEF-rSS and ACEF score, respectively, p = .029; IDI = 0.014, p < .001). Compared with all other SYNTAX-derived risk scores, ACEF-rSS had significantly better discrimination ability based on ROC curve analysis, net reclassification improvement, and IDI.
Combining the ACEF score with rSS to produce the ACEF-rSS enhanced the predictive ability for long-term cardiac mortality.
通过整合残余 SYNTAX 评分（rSS），提高经皮冠状动脉介入治疗（PCI）后年龄、肌酐和射血分数（ACEF）评分的预后价值。
ACEF 评分是为预测择期心脏手术中的手术死亡率而提出的，已在多项研究中得到验证。然而，它并未纳入用于评估接受 PCI 的患者的冠状动脉病变相关变量。
我们纳入了 2013 年在我院接受 PCI 的 10072 例患者。终点为 PCI 后 2 年的心脏死亡，定义为非心脏原因引起的死亡。根据其估计系数，ACEF-rSS 是通过 ACEF 评分和 rSS 的增量权重构建的。
2 年内有 63 例患者（0.63%）发生心脏死亡。多变量分析显示，ACEF 评分和 rSS＞8 与心脏死亡风险独立相关。ACEF-rSS 的计算方法为年龄（岁）/射血分数（%）+1（如果肌酐≥2.0mg/dl）+1（如果 rSS＞8）。基于接收者操作特征（ROC）曲线分析和综合判别改善（IDI），ACEF-rSS 的判别能力明显优于 ACEF 评分（C 统计量分别为 ACEF-rSS 和 ACEF 评分的 0.835 和 0.776，p=0.029；IDI=0.014，p＜0.001）。与所有其他 SYNTAX 衍生风险评分相比，ACEF-rSS 基于 ROC 曲线分析、净重新分类改善和 IDI 具有更好的判别能力。
将 ACEF 评分与 rSS 相结合产生 ACEF-rSS，提高了长期心脏死亡率的预测能力。
