• JuJae-WooJWDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea., Karam Nam, Hyunsook Hong, Hyeon Cheun, Jinyoung Bae, Seohee Lee, Youn Joung Cho, and Yunseok Jeon.
• Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
• J Clin Anesth. 2022 Aug 1; 79: 110693.

Study ObjectiveThe age, creatinine, and ejection fraction (ACEF) I and II scores are known to predict operative mortality after cardiac surgery. However, data from few cases of off-pump coronary artery bypass grafting (OPCAB) were considered during the development of these scores. This study aimed to validate and update the ACEF I and II scores for the prediction of in-hospital mortality after OPCAB.DesignSingle-center retrospective observational study.SettingTertiary university hospital.PatientsAll adult patients (≥18 years) who underwent isolated OPCAB between 2011 and 2020 were included in our analysis.MeasurementsPredicted in-hospital mortality after OPCAB was calculated using ACEF and ACEF II scores. Performance of ACEF I and II scores in predicting in-hospital mortality after OPCAB was evaluated using receiver operating characteristics curves and calibration plots. Scores were recalibrated and modified using the closed testing procedure and multivariable fractional polynomial analysis.Main ResultsIn total, 1450 patients were analyzed. The ACEF I and II scores discriminated in-hospital mortality with the c-statistics of 0.86 and 0.83, respectively. The calibration plots revealed that both scores overestimated the risk of in-hospital mortality. The ACEF I score was recalibrated by re-estimating only the model intercept. The ACEF II score was modified by substituting hematocrit with left main coronary artery disease. The c-statistic of the updated ACEF II score increased to 0.86. Both the updated ACEF I and II scores were well-calibrated.ConclusionsThe ACEF I and II scores discriminated in-hospital mortality after OPCAB with excellent accuracy, although calibration properties were suboptimal. The updated scores showed even better discrimination and calibration. Thus, the ACEF I and ACEF II scores can be relatively straightforward and useful tools for prognostication of patients undergoing OPCAB.Copyright © 2022 Elsevier Inc. All rights reserved.

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