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Validation of Biomarker-Based ABCD Score in Atrial Fibrillation Patients with a Non-Gender CHA2DS2-VASc Score 0-1: A
Moonki Jung1, Kyeongmin Byeon1, Ki-Woon Kang2
1Department of Cardiology, Heart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, Gwangmyeong, Korea.
Insights
The ABCD score improves stroke risk assessment in atrial fibrillation (AF) patients with low CHA2DS2-VASc scores. Non-vitamin K antagonist oral anticoagulant (NOAC) therapy further reduces stroke risk in higher-risk AF patients identified by the ABCD score.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Atrial fibrillation (AF) patients with low to intermediate risk (non-gender CHA2DS2-VASc score 0-1) remain susceptible to stroke.
- Existing risk stratification tools may not fully capture the stroke risk in this patient population.
- Accurate risk assessment is crucial for guiding antithrombotic therapy decisions.
Purpose of the Study:
- To validate the utility of the ABCD score for stroke risk stratification in AF patients with a non-gender CHA2DS2-VASc score of 0-1.
- To compare the performance of the ABCD score against the non-gender CHA2DS2-VASc score for stroke risk prediction.
- To evaluate the impact of antithrombotic therapy, particularly NOACs, on stroke rates in conjunction with the ABCD score.
Main Methods:
- Retrospective multi-center cohort study analyzing 2694 AF patients with a non-gender CHA2DS2-VASc score of 0-1.
- Primary endpoint: incidence of stroke, assessed with and without antithrombotic therapy (ATT).
- Validation of the ABCD score (Age, BNP, Creatinine clearance, Left Atrial Dimension) for risk stratification.
Main Results:
- The ABCD score demonstrated superior stroke risk stratification compared to the non-gender CHA2DS2-VASc score (C-index=0.618, p=0.015).
- Patients with an ABCD score ≥1 had a higher stroke rate (1.02/100 P-Y) than those with an ABCD score of 0 (0.46/100 P-Y).
- In patients receiving NOACs, an ABCD score ≥1 was associated with a significantly lower stroke rate (0.44/100 P-Y) compared to those without ATT (1.55/100 P-Y).
Conclusions:
- The biomarker-based ABCD score offers improved stroke risk stratification for AF patients with low-risk CHA2DS2-VASc scores.
- The ABCD score can identify AF patients who may benefit from intensified antithrombotic strategies.
- NOAC therapy in conjunction with an ABCD score ≥1 significantly reduces stroke incidence in this AF population.
Purpose:
Atrial fibrillation (AF) patients with low to intermediate risk, defined as non-gender CHA2DS2-VASc score of 0-1, are still at risk of stroke. This study verified the usefulness of ABCD score [age (≥60 years), B-type natriuretic peptide (BNP) or N-terminal pro-BNP (≥300 pg/mL), creatinine clearance (<50 mL/min/1.73 m²), and dimension of the left atrium (≥45 mm)] for stroke risk stratification in non-gender CHA2DS2-VASc score 0-1.
Materials And Methods:
This multi-center cohort study retrospectively analyzed AF patients with non-gender CHA2DS2-VASc score 0-1. The primary endpoint was the incidence of stroke with or without antithrombotic therapy (ATT). An ABCD score was validated.
Results:
Overall, 2694 patients [56.3±9.5 years; female, 726 (26.9%)] were followed-up for 4.0±2.8 years. The overall stroke rate was 0.84/100 person-years (P-Y), stratified as follows: 0.46/100 P-Y for an ABCD score of 0; 1.02/100 P-Y for an ABCD score ≥1. The ABCD score was superior to non-gender CHA2DS2-VASc score in the stroke risk stratification (C-index=0.618, p=0.015; net reclassification improvement=0.576, p=0.040; integrated differential improvement=0.033, p=0.066). ATT was prescribed in 2353 patients (86.5%), and the stroke rate was significantly lower in patients receiving non-vitamin K antagonist oral anticoagulant (NOAC) therapy and an ABCD score ≥1 than in those without ATT (0.44/100 P-Y vs. 1.55/100 P-Y; hazard ratio=0.26, 95% confidence interval 0.11-0.63, p=0.003).
Conclusion:
The biomarker-based ABCD score demonstrated improved stroke risk stratification in AF patients with non-gender CHA2DS2-VASc score 0-1. Furthermore, NOAC with an ABCD score ≥1 was associated with significantly lower stroke rate in AF patients with non-gender CHA2DS2-VASc score 0-1.
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