Multicenter Validation of ACEF II Risk Score: A Reliable Predictive Instrument for CABG Patients

Background: ACEF II score is a parsimonious score for predicting mortality in general cardiac surgery consisting of five variables: age, ejection fraction, serum creatinine level, emergency surgery, and hematocrit. This study aimed to validate the predictive ability of ACEF II score and to compare it to the EuroSCORE II.

Method: A multicenter retrospective data analysis of 14,804 cardiac surgery patients (age: 68.40 ± 11.45, male sex: 9,557 (64.56%), operated on from 2009 to 2019) was conducted. Predictive ability of both ACEF II and EuroSCORE II and comparisons between scores were assessed using ROC curve analysis. Statistical analysis was performed using MedCalc software.

Results: Observed mortality in the cohort was at 2.8%. ACEF II score demonstrated a good performance in predicting death in the general cardiac surgery population. However, EuroSCORE II showed a significantly better predictive ability compared with ACEF II (AUC EuroSCORE II 0.792 vs. AUC ACEF II 0.733, p < 0.001). In a further subanalysis including patients undergoing isolated valve (AUC EuroSCORE II 0.803 vs. AUC ACEF II 0.736, p = 0.015) and aortic surgery (AUC EuroSCORE II 0.748 vs. 0.529, p = 0.006), EuroSCORE II still demonstrated a significantly better performance. However, in patients undergoing isolated CABG, there was no significant difference in predictive ability (AUC EuroSCORE II 0.796 vs. AUC ACEF II 0.765, p = 0.37).

Conclusion: Despite significant lower performance compared with EuroSCORE II, ACEF II risk score still demonstrates a good performance in general cardiac surgery. Those differences disappear when the CABG population is considered. Thus, it is easier applicability and calculation may help identifying CABG cases suitable for resident training.

Publication History

Article published online:
03 February 2022