ACEF II Risk Score for Cardiac Surgery

ACEF II Calculator

Age

years

Left Ventricular Ejection Fraction (LVEF)

Serum Creatinine

mg/dL

Emergency Surgery

ACEF II Score: –

–

Predicts 30-day mortality after elective or emergency cardiac surgery.

Why Use

Provides a quick and validated estimate of 30-day operative mortality risk. Helps facilitate shared decision-making between clinicians and patients by clarifying risk profiles.

When to Use

Use during preoperative risk assessment in patients undergoing elective, urgent, or emergent cardiac surgery.

Formula

ACEF II = (A / EF) + C + Em + Hct, where variables are as follows: Variable Notes A Age, years -- EF Left ventricular ejection fraction, % On most recent assessment C Serum creatinine, 2 points if >2.0 mg/dL (177 µmol/L); 0 if ≤2.0 mg/dL Last recorded value before surgery Em Emergency surgery, 3 points if yes; 0 if no Emergency = operation required before the beginning of the next working day after decision to operate Hct 0.2 x (36 - hematocrit); 0 if hematocrit ≥36% Last recorded value before surgery

Pearls / Pitfalls

This tool is based on the 2018 updated version of the original Age, Creatinine, and Ejection Fraction (ACEF) score, which now includes emergency surgery, anemia, and remodulated coefficients. Unlike other generalized preoperative risk assessment tools, this calculator is derived specifically from a population of individuals who underwent cardiac surgery. Does not account for all potential risk factors, such as frailty, pulmonary disease, or detailed procedural risks, and may underestimate risk in patients with other significant comorbidities. Best used in combination with clinical judgment and other risk assessment tools for a comprehensive evaluation.

Advice

Discuss the calculated risk with the patient and surgical team to align expectations and make informed decisions. Prioritize perioperative optimization, such as improving renal function or addressing modifiable cardiac risk factors. Integrate the score into broader multidisciplinary decision-making, particularly for high-risk patients or those requiring complex procedures. This tool should not be the sole measure of perioperative risk. Consider the implication of other clinical variables and comorbidities (e.g., baseline pulmonary function, liver impairment).

More Information

Interpetation: Predicted 30-day operative mortality = e x / (1 + e x ) where x = -4.86 + 0.75 x ACEF II