A simple prediction tool of long-term all-cause mortality after percutaneous coronary intervention: age/ejection fraction ratio

Introduction: Multiple risk models of predicting adverse events have been extensively validated in patients with coronary artery disease. These risk scores incor-porate numerous clinical and/or angiographic variables and many of them have complicated computation algorithms or need a dedicated software for calculation. Age and left ventricular ejection fraction (EF) are amongst the most powerful independent predictors of mortality in patients with coronary artery disease, both being included in various risk-predicting models, in many of them as a ratio. Although age/EF ratio (AEFR) would be a simple and convenient prognostic tool for coronary artery disease patients, to the best of our knowledge this parameter alone has not been evaluated for this purpose to date.

Methods: The predictive powers of AEFR and five va-lidated clinical and/or angiographic risk models [age, creatinine and EF (ACEF) score; modified ACEF score; discharge Global Registry of Acute Coronary Events (GRACE) score; Synergy between PCI with TAXUS drug-eluting stent and Cardiac Surgery (SYNTAX) score; clinical SYNTAX score] for all-cause 3-year mortality were compared in a population of unselec-ted consecutive patients treated by percutaneous coro-nary intervention (PCI) in the Emergency Institute for Cardiovascular Diseases and Transplantation of Târgu Mureș during the period of 01. January – 31. Decem-ber 2016. The patients were prospectively enrolled in the Institute’s PCI Registry. Long-term mortality data was achieved from the database of the National Health Insurance System.

Results: 907 of the 1178 patients enrolled in the PCI Registry in that period had all the data available for analysis (51.9% with acute coronary syndromes), with a 3-year all-cause mortality of 14.0%. All the studied risk models were significantly associated with 3-year mortality at receiver-operator characteristic (ROC)-curve- and univariate logistic regression analysis (all p< 0.001). The area under the curve for AEFR was 0.79 [95%CI (0.76-0.82)]; an AEFR value of > 1.39 predic-ted 3-year mortality with on Odds Ratio of 7.2 [95%CI (4.6-11.1)], p< 0.001. In comparative ROC-curve analysis, AEFR predicted better 3-year mortality than the SYNTAX score (difference between areas= 0.125, p< 0.001) and equally well as the other four studied risk models (difference between areas calculated for AEFR vs. other scores: vs. ACEF score: 0.015, p= 0.10; vs. modified ACEF score: 0.006, p= 0.66; vs. discharge GRACE score: 0.007, p= 0.64; and vs. clinical SYNTAX score: 0.025, p= 0.27).

Conclusions: Age/ejection fraction ratio is an easy-to-use prognostic tool for predicting long-term all-cause mortality in patients treated by PCI. In the current study, AEFR presented similar or better predictive ability for all-cause three-year mortality than other validated, more complex predictive tools. Further research is needed to validate and to clarify the predictive role of AEFR in different patient populations with coronary artery disease. This study was funded by the Romanian Academy of Medical Sciences and European Regional Development Fund, MySMIS 107124: Funding Contract 2/Axa 1/31.07.2017/ 107124 SMIS.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
ESC search engine
CODE: 379
CME Credits: 10 (Romanian College of Physicians)