Cardiac Surgery Scores

ACEF II Score Calculator – Cardiac Surgery Risk Assessment

Clinical calculation support · Verify results before clinical use

Preoperative Risk Assessment

Enter the patient's preoperative characteristics to calculate the ACEF II score.

—ACEF II

Demographic and cardiac function

Use age in completed years and the most recent preoperative left ventricular ejection fraction.

Age (years) Adult patients; enter completed years.

Left ventricular ejection fraction (%) LVEF expressed as a percentage, not a decimal fraction.

Preoperative laboratory values

Enter serum creatinine and hematocrit measured before surgery.

Serum creatinine (mg/dL) The score adds 2 points only when creatinine is >2.0 mg/dL.

Hematocrit (%) Anemia component applies only when hematocrit is <36%.

Surgical urgency

Select whether the planned cardiac operation is classified as emergency surgery.

No — not emergency

Yes — emergency

Select Yes only when the operation meets the emergency-surgery definition used by your cardiac surgery service. Do not automatically classify every urgent or non-elective operation as an emergency.

—Total score

Calculated ACEF II score

Score calculated

This is a numerical risk score. The original ACEF II publication does not establish universal score bands that convert the result into an individual percentage probability of mortality.

Score components

About the ACEF II Score

The ACEF II score is a parsimonious preoperative risk assessment model developed for patients undergoing cardiac surgery. It updates the original ACEF score by incorporating emergency surgery and preoperative anemia.

The development study evaluated operative mortality, defined as death in hospital or within 30 days after surgery. The score should be interpreted as one component of a comprehensive clinical assessment.

Calculation method

ACEF II = Age / LVEF + creatinine component + emergency component + hematocrit component.

Variable	Criterion	Score contribution
Age and LVEF	Age (years) divided by LVEF (%)	Age / LVEF
Serum creatinine	>2.0 mg/dL	+2 points
Emergency surgery	Emergency operation	+3 points
Hematocrit	<36%	0.2 × (36 − HCT)

Interpretation and limitations

A higher numerical score indicates a greater burden of the model's included risk factors; do not translate it into a mortality percentage using unvalidated cutoffs.
ACEF II was developed and externally validated in specific cardiac surgery cohorts. Performance may vary by institution, case mix, procedure type, and contemporary perioperative practice.
A multicentre external validation found EuroSCORE II had better discrimination in the overall cohort, while performance was comparable in the isolated CABG subgroup.
An Indonesian validation study evaluated the original ACEF score, not ACEF II; it therefore does not establish local validity of ACEF II.
Use a locally validated risk model and multidisciplinary clinical judgement where available. This score is not a substitute for EuroSCORE II, STS models, or individualized assessment.

References

Ranucci M, Pistuddi V, Scolletta S, de Vincentiis C, Menicanti L. The ACEF II Risk Score for cardiac surgery: updated but still parsimonious. European Heart Journal. 2018;39(23):2183–2189. doi:10.1093/eurheartj/ehx228

Santarpino G, et al. Comparison between the age, creatinine and ejection fraction II score and the European System for Cardiac Operative Risk Evaluation II: which score for which patient? European Journal of Cardio-Thoracic Surgery. 2022;61(5):1118–1122. doi:10.1093/ejcts/ezac049

Widyastuti Y, Boom CE, Parmana IMA, et al. Validation in Indonesia of Two Published Scores for Mortality Prediction after Cardiac Surgery. Annals of Cardiac Anaesthesia. 2023;26(1):23–28. This study assessed ACEF (original), not ACEF II. doi:10.4103/aca.aca_297_20

Clinical disclaimer: ACEF II is a risk stratification aid and must not be used as the sole basis for clinical decisions, operative consent, or treatment allocation. Confirm input values and the urgency classification. Consider the patient's full clinical condition, procedure type, institutional outcomes, and locally validated risk estimates.