Age, creatinine, and ejection fraction(ACEF) score: a simple preoperative risk-stratified method for patients with type B aortic dissectionundergoing thoracic endovascular aortic repair

Background
This study aimed to investigate the prognostic significance of the age, creatinine and ejection fraction (ACEF) score in patients with type B aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR).

Methods
The study involved 605 patients, who were classified into three groups according to the tertiles of ACEF score: Tertile 1(≤0.77, n=204), Tertile 2 (0.77 to 0.96, n = 205) and Tertile 3 (>0.96, n = 196).

Results
After a median 3.4 years follow-up, 63 (10.4%) patients died. Multivariable Cox survival analysis revealed that ACEF score was independently associated with long-term mortality (adjusted hazard ratio=3.00; 95% confidence interval, 1.65-5.44; p<0.001). ACEF, AGEF and ACEF II score had similar predictive ability for both in-hospital and long-term death.The in-hospital mortality (1.5% vs. 1.0% vs. 6.6%, p=0.001) and major adverse clinical events (3.9% vs. 4.9% vs. 15.3%, p<0.001) were significantly higher in Tertile 3. In addition, cumulative long-term mortality in Tertile 3 was significantly higher than that in Tertile 1 and 2 (Log-Rank=23.74; p <0.001).

Conclusions
ACEF score was an independent predictor for long-term mortality in TBAD patients undergoing TEVAR, and it could be considered as a useful and relatively simple tool for pre-TEVAR risk stratification.