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Novel model-based point scoring system for predicting stroke risk in atrial fibrillation patients: Results from a
Yun-Yu Chen1,2, Yenn-Jiang Lin1,3, Kuo-Liong Chien2
1Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Insights
A new stroke risk score, AF-CA-Stroke, effectively identifies stroke risk in atrial fibrillation (AF) patients undergoing ablation. This score improves upon existing systems by incorporating ablation status for better stroke prediction.
Area of Science:
- Cardiology
- Medical Informatics
- Stroke Prevention
Background:
- Stroke risk stratification in atrial fibrillation (AF) patients varies, especially concerning ablation status.
- Existing scoring systems may not fully capture risks in patients undergoing catheter ablation.
Purpose of the Study:
- To develop and validate a novel stroke risk scoring system (AF-CA-Stroke score) for AF patients, incorporating catheter ablation status.
- To improve stroke risk stratification in AF patients undergoing ablation.
Main Methods:
- A propensity-score (PS)-matched cohort of 787 AF patients undergoing ablation and 787 controls was used.
- A point-based clinical model was constructed using multivariate Cox model coefficients from the PS-matched cohort.
- The novel AF-CA-Stroke score was validated in a nationwide AF cohort.
Main Results:
- The AF-CA-Stroke score incorporates age, ablation status, prior stroke, chronic kidney disease, diabetes mellitus, and congestive heart failure.
- The score demonstrated strong predictive performance (AUC=0.845) in the PS-matched cohort and superior discrimination compared to CHADS₂/CHA₂DS₂-VASc scores in validation.
- A cut-off value of ≥5 on the AF-CA-Stroke score effectively predicted future strokes.
Conclusions:
- The novel AF-CA-Stroke score is an effective tool for identifying stroke risk in AF patients, utilizing clinical factors and ablation status.
- Consideration of age stratification and AF ablation status is crucial for optimal AF management and stroke prevention.
Background:
The stroke risk scoring system for atrial fibrillation (AF) patients can vary considerably based on patients' status while receiving ablation. This study aimed to demonstrate a novel scoring system for stroke risk stratification based on the status of catheter ablation.
Methods:
First, 787 patients with AF undergoing ablation were matched according to age, sex, and underlying diseases with the same number of patients not undergoing ablation using the propensity-score (PS)-matched cohort. Multivariate Cox model-derived coefficients were used to construct a simple point-based clinical model using the PS-matched cohort. Thereafter, the novel model (AF-CA-Stroke score) was validated in a nationwide AF cohort.
Results:
The AF-CA-Stroke score was calculated based on age (point = 5), ablation status (point = 4), prior history of stroke (point = 4), chronic kidney disease (point = 2), diabetes mellitus (point = 1), and congestive heart failure (point = 1). Risk function to predict the 1-, 5-, 10-year absolute stroke risks was reported. The estimated area under the receive operating characteristic curve of the AF-CA-Stroke score in the PS-matched cohort was 0.845 (95% confidence interval: 0.824-0.865) to predict long-term stroke. A validation study showed that discrimination abilities in the AF-CA-Stroke scores were significantly higher than those in the CHADS2/CHA2DS2-VASc scores. The best cut-off value of the AF-CA-Stroke score to predict future strokes was ≥ 5.
Conclusions:
This novel model-based point scoring system effectively identifies stroke risk using clinical factors and AF ablation status of patients with AF. Various age stratifications and AF ablation should be considered in AF management.
