Incorporating glomerular filtration rate or creatinine clearance by the modification of diet in renal disease equation or the Cockcroft-Gault equations to improve the global accuracy of the Age, Creatinine, Ejection Fraction [ACEF] score in patients undergoing percutaneous coronary intervention

Background: The aim of the present study was to appraise the comparative ability of different ACEF models incorporating glomerular filtration rate or creatinine clearance estimated by the Modification of Diet in Renal Disease [ACEF(MDRD)] or Cokcroft-Gault [ACEF(CG)] equations, respectively, over the original ACEF score (ACEF(SrCr)) in patients undergoing percutaneous coronary intervention (PCI). Methods: A total of 537 patients were analyzed by different measures of discrimination, calibration and net reclassification improvement (NRI). Results: A significant gradient in all-cause mortality was consistently seen with all the models at 30 days, 1 year and 5 years. The comparison of the three models showed that the best balance in terms of discrimination and calibration for all-cause mortality was offered by the ACEF(CG) at 30 days, the ACEF(MDRD) at 1 year and similarly by the ACEF(CG) and ACEF(MDRD) at 5 years. At 30 days, the NRI was + 32.9% for ACEF(MDRD) over ACEF(SrCr) and + 16% for ACEF(CG) over ACEF(SrCr). At 1 year, the NRI was 13.8% for ACEF(MDRD) over ACEF(SrCr) and -7.8% for ACEF(CG) over ACEF(SrCr). At 5 years, the NRI was +7.7% for both the ACEF(MDRD) and the ACEF(CG) over the ACEF(SrCr). Conclusions: In patients undergoing PCI, the ACEF score is associated with satisfactory early-, mid- and long-term discrimination regardless of the definition of renal function. However, incorporating glomerular filtration rate or creatinine clearance by the MDRD or CG formulas in the ACEF score yields superior calibration compared with the original SrCr-based equation, with the ACEF(MDRD) displaying superior reclassification ability over the ACEF(CG) and ACEF(SrCr) at 30 days and 1 year