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Published on: July 20, 2022
Performance and Validation of a Novel Biomarker-Based Stroke Risk Score for Atrial Fibrillation
Jonas Oldgren1, Ziad Hijazi2, Johan Lindbäck2
1From Department of Medical Sciences, Cardiology, Uppsala University, Sweden (J.O., Z.H., L.W.); Uppsala Clinical Research Center, Uppsala University, Sweden (J.O., Z.H., J.L., A.S., L.W.); Duke Clinical Research Institute, Duke Medicine, Durham, NC (J.H.A., C.B.G., R.D.L.); Population Health Research Institute, Hamilton, Canada (S.J.C., J.W.E., S.Y.); Thomas Jefferson Medical College and the Heart Center, Wynnewood, PA (M.D.E.); Boston University Medical Center, MA (E.M.H.); and Department of Medical Sciences, Clinical Chemistry, Uppsala University, Sweden (A.S.). jonas.oldgren@ucr.uu.se.
Insights
The ABC-stroke score, incorporating age, biomarkers, and clinical history, offers improved stroke risk prediction in atrial fibrillation patients compared to CHA₂DS₂-VASc and ATRIA scores.
Area of Science:
- Cardiology
- Clinical Risk Stratification
- Biomarker Research
Background:
- Atrial fibrillation (AF) presents a variable stroke risk.
- Existing risk scores like CHA₂DS₂-VASc and ATRIA have limitations in predicting stroke events.
- Biomarker integration offers potential for enhanced risk assessment in AF.
Purpose of the Study:
- To validate the novel biomarker-based ABC-stroke risk score.
- To compare the performance of the ABC-stroke score against established CHA₂DS₂-VASc and ATRIA scores.
- To assess the utility of ABC-stroke score in anticoagulated AF patients.
Main Methods:
- Validation cohort from the RE-LY study (n=8356).
- Analysis of 16,137 person-years with 219 adjudicated stroke/systemic embolic events.
- Measurement of N-terminal fragment B-type natriuretic peptide and high-sensitivity cardiac troponin (hs-cTnT/hs-cTnI).
Main Results:
- The ABC-stroke score demonstrated good calibration across low, medium, and high-risk strata.
- ABC-stroke score achieved higher predictive accuracy (C-indices of 0.65) than CHA₂DS₂-VASc (0.60) and ATRIA (0.61).
- Hazard ratios indicated significantly increased stroke risk in medium (1.95) and high (3.44) risk groups compared to low risk.
Conclusions:
- The ABC-stroke score is a well-calibrated and superior predictor of stroke events in AF.
- Biomarker incorporation enhances stroke risk assessment beyond traditional clinical factors.
- The ABC-stroke score serves as an improved decision support tool for AF management.
Background:
Atrial fibrillation is associated with increased but variable risk of stroke. Our aim was to validate the recently developed biomarker-based ABC (age, biomarkers [high-sensitivity troponin and N-terminal fragment B-type natriuretic peptide], and clinical history of prior stroke/transient ischemic attack)-stroke risk score and compare its performance with the CHA2DS2VASc and ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) risk scores.
Methods:
The ABC-stroke score includes age, biomarkers (N-terminal fragment B-type natriuretic peptide and high-sensitivity cardiac troponin), and clinical history (prior stroke). This validation was based on 8356 patients, 16 137 person-years of follow-up, and 219 adjudicated stroke or systemic embolic events in anticoagulated patients with atrial fibrillation in the RE-LY study (Randomized Evaluation of Long-Term Anticoagulation Therapy). Levels of N-terminal fragment B-type natriuretic peptide, high-sensitivity cardiac troponin T (hs-cTnT), and high-sensitivity cardiac troponin I (hs-cTnI) were determined in plasma samples obtained at study entry.
Results:
The ABC-stroke score was well calibrated with 0.76 stroke/systemic embolic events per 100 person-years in the predefined low (<1%/y) risk group, 1.48 in the medium (1%-2%/y) risk group, and 2.60 in the high (>2%/y) risk group for the ABC-stroke score with hs-cTnT. Hazard ratios for stroke/systemic embolic events were 1.95 for medium- versus low-risk groups, and 3.44 for high- versus low-risk groups. ABC-stroke score achieved C indices of 0.65 with both hs-cTnT and hs-cTnI, in comparison with 0.60 for CHA2DS2VASc (P=0.004 for hs-cTnT and P=0.022 hs-cTnI) and 0.61 for ATRIA scores (P=0.005 hs-cTnT and P=0.034 for hs-cTnI).
Conclusions:
The biomarker-based ABC-stroke score was well calibrated and consistently performed better than both the CHA2DS2VASc and ATRIA stroke scores. The ABC score should be considered an improved decision support tool in the care of patients with atrial fibrillation.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifiers: ARISTOTLE, NCT00412984; RE-LY, NCT00262600.
