Comparison of the ACEF score in predicting short-term mortality among elderly versus non-elderly patients with ST-segment elevation myocardial infarction

DENG Li-zhi; GAO Jing; HE Yu-ying; LIAO You-wan

doi:10.3969/j.issn.1009-8933.2025.04.009

Abstract：Background Although the age, creatinine, and ejection fraction (ACEF) score effectively predicts risk in general populations with ST segment elevation myocardial infarction (STEMI), its performance specifically in elderly patients—who are often underrepresented in validation studies and present with unique pathophysiology—is not well established. This study was designed to directly evaluate and compare the predictive value of the ACEF score for short-term mortality in elderly versus non-elderly STEMI patients, addressing a critical gap in its clinical application. Methods We enrolled 934 consecutive STEMI patients undergoing percutaneous coronary intervention, categorized into a non elderly group (<65 years, n=534) and an elderly group (≥65 years, n=400). The ACEF score was calculated as age/left ventricular ejection fraction + 1 (if serum creatinine >2 mg/dL). Its predictive ability for in hospital and one year mortality was assessed. Results Overall, in hospital and one year mortality rates were 4.4% and 8.2%, respectively. Elderly patients had significantly worse in hospital outcomes, including higher all cause mortality (6.5% vs. 2.8%, P=0.006) and major adverse cardiovascular events (16.0% vs. 9.2%, P=0.002). The predictive performance of the ACEF score for in hospital mortality was lower in the elderly group than in the non elderly group (area under the curve: 0.753 vs. 0.828, P=0.047). The optimal cut off value for ACEF was 1.65 in both groups. In multivariate analysis, an ACEF score >1.65 independently predicted in hospital mortality [adjusted odds ratio (OR): 11.58, P=0.001] and one year mortality [adjusted hazard ratio (HR): 7.12, P<0.001] in non elderly patients. Similar associations were observed in elderly patients (in hospital mortality: adjusted OR: 3.26, P=0.027; one year mortality: adjusted HR: 2.79, P=0.003). Conclusions Despite a relatively lower discriminatory ability for short-term mortality in elderly STEMI patients, the ACEF score still demonstrated significant predictive value and might serve as a practical, initial tool for identifying high-risk individuals in clinical settings. [S Chin J Cardiol 2025;26(4):284-291]