Predictive Value Of Modified ACEF Score For The Efficacy Of Rotational Atherectomy And Drug-eluting Stent Implantation In Patients With Severe Coronary Artery Calcification

ObjectiveSevere coronary artery calcification(CAC)is one of the difficulties in percutaneous coronary intervention(PCI).Although coronary rotational atherectomy(RA)is an effective method for the treatment of severe CAC,the clinical prognosis of postoperative patients is still poor.At present,ACEF score has been used to evaluate patients with complex lesions such as left main coronary artery disease,bifurcation lesion and chronic total occlusion after PCI,but there is no effective index to predict the clinical effect of PCI in patients with severe CAC disease.The main discussion of this study is to explore the value of ACEF score and m ACEF score in predicting the short-term clinical efficacy of RA and DES implantation in patients with severe coronary artery calcification.At the same time,the ACEF score and m ACEF score model were improved to classify patients with severe CAC treated with DES implantation after RA according to risk stratification,so as to better formulate the next treatment plan for patients.MethodThis study was retrospectively included patients with severe CAC were implanted with DES after RA treatment and followed up one year in the Department of Cardiology of the affiliated Provincial Hospital of Anhui Medical University from January 2017 to July 2020.Basic data on admission were collected,including sex,age,body mass index(BMI),past medical history,smoking history,creatinine,glomerular filtration rate(GFR),left ventricular ejection fraction(LVEF),angiographic findings and interventional therapy,including the location of the lesion,the number of stents implanted and the use of intravascular ultrasound(IVUS)and intra-aortic balloon pump(IABP).According to the occurrence of major adverse cardiovascular events(MACE,including cardiogenic death,recurrent myocardial infarction,target vascular revascularization),during the 1-year follow-up,the patients were divided into MACE group and non-MACE group,and the related factors affecting the prognosis were analyzed.At the same time,according to ACEF score and m ACEF score,they were divided into low score group(ACEF score<1.12 and m ACEF score<1.21),middle score group(ACEF score:1.12-1.44,m ACEF score:1.21-2.79)and high score group(ACEF score>1.44,m ACEF score>2.79).The statistical significance of MACE events in each group was analyzed.ROC curve was used to verify the ability of ACEF score and m ACEF score to predict the prognosis of patients,and combined with the prognostic risk factors,ACEF score and m ACEF score were improved.Results1.A total of 226 patients were eligible,excluding data loss and loss of follow-up,and a total of 206 patients were included in the study.During the 1-year follow-up,35 cases(17.0%)of MACE events occurred in the MACE group and 171cases(83%)in the non-Mace group.The results showed that the proportion of smoking was higher,the cardiac and renal function was worse,and the number of stents was more in MACE group(all P < 0.05).2.The incidence of MACE events in the high score group of ACEF score and m ACEF score was significantly higher than that in the low score group(27.9%-30.9% VS4.3%-7.1%,P<0.05).3.The results of ROC curve analysis showed that ACEF score and m ACEF score could effectively predict the occurrence of MACE events within one year in patients with severe CAC who were treated with RA and implanted DES.The ROC area under curve(AUC)was 0.698 and 0.720 respectively,the sensitivity was 80.00% and 74.29%,and the specificity was 53.22% and 62.57%,respectively.The AUC of m ACEF score was higher,but there was no statistical difference between ACEF score and ACEF score(P >0.05).4.Logistic multivariate regression analysis showed that smoking history and the number of stents were independent risk factors for the prognosis of patients with severe CAC who were treated with RA and implanted DES.On the basis of m ACEF score,a new scoring model was established after introducing two risk factors of smoking history and the number of stents: m ACEF-SS score was better than ACEF score(AUC: 0.786 VS 0.698,P=0.046)and m ACEF score(AUC: 0.786 VS 0.720,P=0.092).ConclusionACEF score and m ACEF score are effective indicators to predict the short-term prognosis of patients with severe CAC who were treated with RA and implanted DES,and m ACEF score is better than ACEF score.MACEF score combined with smoking history and the number of stents implanted to establish m ACEF-SS score model can better predict the short-term prognosis of patients.