Assessing ACEF Score for Mortality in ST-elevation Myocardial Infarction with Primary Percutaneous Coronary Intervention

Abstract

Due to the increasing prevalence and diagnosis of acute myocardial infarction in the last decade and the consequent increase in the incidence of MACE and the urgent need for an available and easy index to estimate the risk of primary angioplasty, and lack of national study on this issue and value, in this study, we investigate the effect of ACEF score on the mortality of STEMI patients undergoing primary angioplasty. Materials and methods: After the approval of the Research Council of Tabriz University of Medical Sciences and the ethics committee of the faculty of medicine, the numerical values of creatinine, age, CTNI and demographic indices and ejection fraction were extracted from the clinical record. The ACEF score was calculated according to the following formula: ACEF=age/left ventricular ejection fraction+1 (if creatinine was >2.0 mg/dL). The diagnosis of STEMI was defined based on the criteria of the American Heart Association, including clinical features associated with ST-segment elevation and positive cardiac enzymes. The ejection fraction was calculated by 2D echo by cardiologists at the time of emergency visit Results: 400 eligible patients were selected for this study, and finally, after excluding patients with incomplete information in medical records, 375 eligible patients entered the final analysis of the study. 305 study participants (81.3%) were male and 70 (18.7%) were female. The mean age of patients was 59.21 ± 11.26. According to the ROC curve, the ACEF score of 2.2310 was the best cut-off for predicting the total number of in-hospital and 30-day mortality as well as in-hospital mortality alone. Also, 1.785 was the best cut-off for predicting the occurrence of MACCE based on the ACEF index. According to the calculated AUCs, the highest predictive values were related to hospital mortality 0.869 (0.77-0.97), total 30-day hospital mortality 0.857 (0.76-0.954) and finally MACCE 0.666 (0.604-0.729), respectively. Patients with ACEF> 2.2310 were older, had lower left ventricular function, had a higher history of vascular disease, and had higher troponin, lower hemoglobin, and higher white blood cells. All of these indicated a higher risk of nosocomial complications and mortality. Patients with ACEF> 1.7850 also had older age, lower left ventricular function, higher prevalence of vascular disease, and lower in vitro triglyceride and hemoglobin, and higher CTNI and FBS.