Marco Ranucci1, Valeria Pistuddi1, Sabino Scolletta2, Carlo de Vincentiis3, Lorenzo Menicanti3. 1. Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese (Milan), Italy. 2. Department of Medical Biotechnologies, Anesthesia and Intensive Care, University Hospital Santa Maria alle Scotte, Viale Bracci,16-53100 Siena, Italy. 3. Department of Cardiac Surgery, IRCCS Policlinico San Donato, Via Morandi, 30-20097 San Donato Milanese (Milan), Italy.
Abstract
Aims: The age, creatinine, and ejection fraction (ACEF) score was introduced in 2009 and is presently included in the guidelines for myocardial revascularization of the European Society of Cardiology and Association for Cardio-Thoracic Surgery as a risk stratification tool for surgical and percutaneous myocardial revascularization. The present study introduces an updated version of the ACEF (ACEF II) inclusive of emergency surgery and pre-operative anaemia. Methods and results: The development series includes 7011 consecutive cardiac surgery patients operated at a single institution. The validation series includes 1687 consecutive cardiac surgery patients operated in a different institution. The five factors included in the ACEF II were assessed in a multivariable logistic regression model testing their independent role as predictors of operative (in hospital or 30 days after surgery) mortality. Based on the odds ratio of each predictor, the ACEF II score is calculated as age(years)/ejection fraction (%). Additional points are attributed to a serum creatinine level > 2 mg/dL (2 points), emergency surgery (3 points) and anaemia [haematocrit (HCT) < 36%, 0.2 points per each HCT point below 36%]. The final model was well calibrated. Discrimination of the ACEF II (c-statistics 0.814) was significantly (P = 0.041) better than the ACEF (c-statistics 0.773) and equal to the EuroSCORE II. In the external validation, the ACEF II confirmed a better discrimination than the ACEF and good calibration properties. Conclusion: The ACEF II allows the inclusion of emergency patients and, through a re-modulation of the coefficients and the inclusion of anaemia, appears more adequate to the present cardiac surgery scenario.
Aims: The age, creatinine, and ejection fraction (ACEF) score was introduced in 2009 and is presently included in the guidelines for myocardial revascularization of the European Society of Cardiology and Association for Cardio-Thoracic Surgery as a risk stratification tool for surgical and percutaneous myocardial revascularization. The present study introduces an updated version of the ACEF (ACEF II) inclusive of emergency surgery and pre-operative anaemia. Methods and results: The development series includes 7011 consecutive cardiac surgery patients operated at a single institution. The validation series includes 1687 consecutive cardiac surgery patients operated in a different institution. The five factors included in the ACEF II were assessed in a multivariable logistic regression model testing their independent role as predictors of operative (in hospital or 30 days after surgery) mortality. Based on the odds ratio of each predictor, the ACEF II score is calculated as age(years)/ejection fraction (%). Additional points are attributed to a serum creatinine level > 2 mg/dL (2 points), emergency surgery (3 points) and anaemia [haematocrit (HCT) < 36%, 0.2 points per each HCT point below 36%]. The final model was well calibrated. Discrimination of the ACEF II (c-statistics 0.814) was significantly (P = 0.041) better than the ACEF (c-statistics 0.773) and equal to the EuroSCORE II. In the external validation, the ACEF II confirmed a better discrimination than the ACEF and good calibration properties. Conclusion: The ACEF II allows the inclusion of emergency patients and, through a re-modulation of the coefficients and the inclusion of anaemia, appears more adequate to the present cardiac surgery scenario.
Authors: Anna Zamperoni; Greta Carrara; Massimiliano Greco; Carlotta Rossi; Elena Garbero; Giovanni Nattino; Giuseppe Minniti; Paolo Del Sarto; Guido Bertolini; Stefano Finazzi Journal: J Clin Med Date: 2022-06-06 Impact factor: 4.964