Correlation Between ACEF Score With Long-term Prognosis Of Patients With Acute ST-segment Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention

Objective: To explore correlation between ACEF score(age,creatinine and left ventricular ejection fraction score,ACEF score)with long-term prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PPCI).Methods: A total of351 STEMI patients undergoing PPCI from September 2016 to June 2018 in Hebei General Hospital were considered eligible.Patients were divided into group A(ACEF<1.312)and group B(ACEF≥1.312);Patients’ baseline data and angiography results were recorded in detail.Data on all-cause death and cardiogenic death were obtained from medical records or telephone interviews until December 31,2020.Baseline and prognosis data on the two groups were compared and analyzed.ROC curve was performed to analyze and compare the predictive ability of ACEF score and SYNTAX score for all-cause death.Kaplan-Meier survival curve and Log-rank test were used to estimate and compare the cumulative survival rate of different groups.To assess the value of ACEF score for predicting the prognosis in patients with STEMI after PPCI,Multivariate Cox regression analysis was performed.Results: Compared with group A,patients in group B were older(56.3±10.9vs.70.8±8.7,P<0.001)and they had a higher percentage of a history of stroke(13.2%vs.25.6%,P=0.008).The proportion of high KILLIP class was higher in group B(1.8%vs.12.8%,P<0.001).The estimated glomerular filtration rate(91.0±14.7vs.76.4±17.3,P<0.001)was lower and peak CK-MB(creatine kinase-MB)(150.0±123.9vs.188.9±158.4,P=0.023)in group B was higher than group A.Compared with group A,the total ischemic time of patients in group B was longer(243.9±201.0vs.275.5±182.1,P=0.012).Group B had a higher proportion of patients with anterior wall myocardial infarction(45.8%vs.65.4%,P=0.002)and left anterior descending as culprit vessel(43.2%vs.62.8%,P<0.05).The proportion of patients with high SYNTAX score(18.9±8.6vs.22.7±9.5,P<0.001)was higher in group B.The all-cause mortality(2.9%vs.10.3%,P=0.006)and cardiogenic mortality(1.8%vs.9.0%,P=0.002)were both higher in patients of group B.The ROC curve revealed that ACEF score(AUC:0.656,95%CI 0.528-0.785,P=0.035)and SYNTAX score(ACU : 0.685,95%CI 0.534-0.836,P=0.012)had same ability of predicting the prognosis in patients with STEMI after PPCI(P=0.720).Calculating the Youden index and the optimum boundary value of ACEF score which was 1.312(sensitivity 0.556,specificity 0.766).Kaplan-Meier life curves showed that patients in group B displayed higher all-cause mortality(P=0.007)and cardiac mortality(P=0.007)than group A.The multi-factors COX regression revealed that ACEF≥1.312(HR3.0,95%CI1.1-8.0,P=0.032)、history of angina(HR5.4,95%CI 1.6-19.2,P=0.009)、SYNTAX≥23(HR6.1,95%CI 1.9-19.1,P=0.002)are independent risk factors for all-cause death of STEMI patients undergoing PPCI.And ACEF≥1.312(HR5.3,95%CI 1.4-16.8,P=0.015)、history of angina(HR8.0,95%CI 1.4-44.5,P=0.018)、KILLIP≥3(HR8.0,95%CI 1.1-20.4,P=0.040)are independent risk factors for cardiac death of STEMI patients undergoing PPCI.And application of statins after PPCI is an independent protective factor for cardiac death of STEMI patients undergoing PPCI.Conclusions: High ACEF score,history of angina and high SYNTAX score are independent risk factors for all-cause death of STEMI patients undergoing PPCI.High ACEF score,history of angina and high KILLIP class are independent risk factors for cardiac death of STEMI patients undergoing PPCI.And application of statins after PPCI is an independent protective factor for cardiac death of STEMI patients undergoing PPCI.Otherwise,ACEF score have a predictive value for the long-term prognosis of STEMI patients after PPCI.