Ply Chichareon1, Rodrigo Modolo2, David van Klaveren3, Kuniaki Takahashi4, Norihiro Kogame4, Chun-Chin Chang5, Yuki Katagiri4, Mariusz Tomaniak6, Taku Asano4, Ernest Spitzer7, Pawel Buszman8, Janusz Prokopczuk9, Farzin Fath-Ordoubadi10, Ian Buysschaert11, Richard Anderson12, Keith G Oldroyd13, Bela Merkely14, Scot Garg15, Joanna J Wykrzykowska4, Jan J Piek4, Peter Jüni16, Christian Hamm17, Philippe Gabriel Steg18, Marco Valgimigli19, Pascal Vranckx20, Stephan Windecker19, Yoshinobu Onuma5, Patrick W Serruys21. 1. Amsterdam UMC, University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand. 2. Amsterdam UMC, University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil. 3. Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands. 4. Amsterdam UMC, University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam, the Netherlands. 5. Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands. 6. Department of Cardiology, Erasmus Medical Centre, Thorax Centre, Rotterdam, the Netherlands; First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. 7. Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands; Cardialysis Clinical Trials Management and Core Laboratories, Westblaak 98, Rotterdam, the Netherlands. 8. Medical University of Silesia, Katowice, Poland; American Heart of Poland, Ustron, Poland. 9. IV Department of Cardiology, American Heart of Poland, Kędzierzyn Koźle, Poland. 10. Manchester Heart Centre, Manchester Royal Infirmary, Manchester University Foundation Trusts, Oxford Rd, Manchester M13 9WL, United Kingdom. 11. Department of Cardiology, ASZ Hospital Aalst, Merestraat 80, 9300 Aalst, Belgium. 12. Cardiff and Vale University Health Board Heath Park, Cardiff, Wales, United Kingdom. 13. West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom. 14. Heart and Vascular Center, Semmelweis University, Budapest, Hungary. 15. East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom. 16. Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Canada. 17. Kerckhoff Heart Center, Campus University of Giessen, Bad Nauheim, Germany. 18. FACT, French Alliance for Cardiovascular Trials, Hôpital Bichat, AP-HP, Université Paris-Diderot, INSERM U-1148, Paris, France; Royal Brompton Hospital, Imperial College, London, United Kingdom. 19. Department of Cardiology, Bern University Hospital, Bern, Switzerland. 20. Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium. 21. NHLI, Imperial College London, London, United Kingdom. Electronic address: patrick.w.j.c.serruys@gmail.com.
Abstract
BACKGROUND: ACEF score has been shown to have predictive ability in the patients undergoing percutaneous coronary intervention (PCI). The ACEF II score has recently been developed to predict short-term mortality after cardiac surgery. We compared the predictive ability of the ACEF and ACEF II scores to predict mortality after PCI in the all-comers population. METHODS: The ACEF and ACEF II scores were calculated in 15,968 patients enrolled in the GLOBAL LEADERS study. Discrimination and calibration were assessed for outcomes after PCI. Recalibration of the regression model by updating the intercept and slope were performed to adjust the original ACEF model to the PCI setting. In a stratified approach, patients were divided into quintiles according to the score. Outcomes were compared between quintiles. RESULTS: The ACEF and ACEF II score were available in 14,941 and 14,355 patients respectively. Discrimination for 30-day all-cause mortality was acceptable for both scores (C-statistic ACEF 0.75 and ACEF II 0.77). For 2-year all-cause mortality, the discrimination of ACEF score was acceptable (C-statistic 0.72) while the discrimination of ACEF II score was moderate (C-statistic 0.69). Both scores identified patients at high risk of mortality but overestimated all-cause mortality at 30 days in all quintiles. After recalibration, agreement between predicted and observed 30-day all-cause mortality in both scores are close to the identity line. CONCLUSIONS: The ACEF II model did not improve the predictive ability of the ACEF score. Recalibrated ACEF model can be used to estimated all-cause mortality rate at 30 days after PCI.
RCT Entities:
BACKGROUND: ACEF score has been shown to have predictive ability in the patients undergoing percutaneous coronary intervention (PCI). The ACEF II score has recently been developed to predict short-term mortality after cardiac surgery. We compared the predictive ability of the ACEF and ACEF II scores to predict mortality after PCI in the all-comers population. METHODS: The ACEF and ACEF II scores were calculated in 15,968 patients enrolled in the GLOBAL LEADERS study. Discrimination and calibration were assessed for outcomes after PCI. Recalibration of the regression model by updating the intercept and slope were performed to adjust the original ACEF model to the PCI setting. In a stratified approach, patients were divided into quintiles according to the score. Outcomes were compared between quintiles. RESULTS: The ACEF and ACEF II score were available in 14,941 and 14,355 patients respectively. Discrimination for 30-day all-cause mortality was acceptable for both scores (C-statistic ACEF 0.75 and ACEF II 0.77). For 2-year all-cause mortality, the discrimination of ACEF score was acceptable (C-statistic 0.72) while the discrimination of ACEF II score was moderate (C-statistic 0.69). Both scores identified patients at high risk of mortality but overestimated all-cause mortality at 30 days in all quintiles. After recalibration, agreement between predicted and observed 30-day all-cause mortality in both scores are close to the identity line. CONCLUSIONS: The ACEF II model did not improve the predictive ability of the ACEF score. Recalibrated ACEF model can be used to estimated all-cause mortality rate at 30 days after PCI.