Serial assessment of biomarkers and the risk of stroke or systemic embolism and bleeding in patients with atrial...

Area of Science:

• Cardiology
• Biomarker Research
• Clinical Trials

Background:

• Atrial fibrillation (AF) patients face risks of stroke and bleeding.
• Assessing dynamic biomarker changes over time can refine risk prediction.

Purpose of the Study:

• To investigate changes in high-sensitivity troponin T (hsTnT), NT-proBNP, and GDF-15 over 12 months in AF patients.
• To determine if these biomarker changes correlate with subsequent risks of stroke/systemic embolic events (S/SEE) and bleeding.

Main Methods:

• Prospective biomarker analysis in 6308 AF patients from the ENGAGE AF-TIMI 48 trial.
• Measurement of hsTnT, NT-proBNP, and GDF-15 at baseline and 12 months.
• Cox regression and reclassification analyses using ABC-stroke and ABC-bleeding scores.

Main Results:

• Significant biomarker dynamics observed: hsTnT (46.9%), NT-proBNP (51.9%), GDF-15 (45.6%) showed notable changes.
• Increased hsTnT and NT-proBNP associated with higher S/SEE risk (adj-HR 1.74, 1.27).
• Increased GDF-15 associated with higher bleeding risk (adj-HR 1.40).
• ABC risk scores at 12 months accurately reclassified patient risk compared to baseline (NRI 0.50 for stroke, 0.42 for bleeding).

Conclusions:

• Serial biomarker assessment reveals dynamic changes in a substantial proportion of AF patients.
• Increases in hsTnT, NT-proBNP, and GDF-15 over one year are linked to adverse clinical outcomes in anticoagulated AF patients.
• Dynamic biomarker assessment improves risk stratification for stroke and bleeding in AF management.