| Objective: To investigate the predictive value of ACEFⅡscore for incidence of major adverse cardiovascular and cerebrovascular events(MACCEs)in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods: From July 2020 to September 2021,445 patients with CHD who underwent PCI at the the Second Affiliated Hospital of Soochow University,and met the inclusion criteria were consecutively enrolled.The ACEFⅡscore was calculated based on the in-hospital age,serum creatinine value,left ventricular ejection fraction,hematocrit and the condition whether emergency operation was performed at admission of patients,and the patients were divided into two groups based on the score,ACEFⅡhigh-score group(ACEFⅡscores≥1.461,n=227)and low-score group(ACEFⅡscores<1.461,n=218).Detailed clinical baseline,laboratory and imaging data of patients were collected,and the data of MACCE was obtained by telephone interviews and follow-up visits through the readmission records.The median follow-up period was 12 months.Baseline and follow-up data were compared between the two groups.The receiver operating characteristic(ROC)curve was selected to compare the predictive power of the ACEFⅡscore and Gensini score for MACCEs.Then,Kaplan-Meier survival curve and Log-rank test were chosen for survival analysis of adverse prognosis between groups.Finally,multivariate Cox proportional risk regression analysis was used to investigate independent risk or protective factors for MACCE in patients with CHD after PCI.Results: Comparison of baseline data between the two groups showed that patients in the ACEFⅡhigh-score group were significantly older,under poorer control of blood glucose and lipid,and subject to worse cardiac and renal functions as well as more severe anemia and coronary artery lesions.Additionally,a significantly larger proportion of patients in the high-score group underwent emergency PCI for acute myocardial infarction(AMI)and had the history of atrial fibrillation and heart failure.Comparison of the follow-up results between the two groups showed a significantly higher incidence of MACCE in the high-score group(22.03% vs.5.96%,P<0.001).The areas under the ROC curve of ACEFⅡand Gensini scores were 0.718(95%CI0.651-0.784,P<0.001),0.599(95%CI 0.524-0.674,P=0.012),and a comparative analysis of the areas under the curve showed the predictive value of ACEFⅡscore was much better(P<0.05).ACEFⅡscore had a best cut-off value of 1.461,a maximum Jorden index of 0.331,a sensitivity of 79.4% and a specificity of 53.7%.Survival analysis suggested that the high-score group had a significantly lower cumulative MACCE-free survival rate than the low-score group(p<0.001).Multivariate Cox regression analysis showed ACEFⅡscores ≥1.461(HR=3.366,95%CI 1.726-6.565,P<0.001),Gensini scores ≥61.5(HR=1.788 95%CI 1.059-3.022,P=0.030),age(HR=1.028,95% CI 1.005-1.051,P=0.016),levels of c Tn I(HR=1.023,95%CI1.010-1.036,P<0.001)and previous PCI(HR=2.905,95%CI 1.609-5.246,P<0.001)were independent risk factors influencing the incidence of MACCE after PCI in patients with CHD,while the utilization of statin(HR=0.068,95%CI 0.027-0.170,P<0.001)was an independent protective factor.Conclusions: The ACEFⅡscore has an ideal capacity for risk stratification in patients with CHD undergoing PCI treatment and offers good predictive value for MACCE after PCI.ACEFⅡscores ≥1.461,Gensini scores ≥61.5,age,in-hospital levels of troponin I and previous PCI were independent risk factors for MACCE after PCI in patients with CHD,while the utilization of statins was an independent protective factor. |
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