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Biomarker-Based Model for Prediction of Ischemic Stroke in Patients With Atrial Fibrillation
Lars Wallentin1, Johan Lindbäck2, Ziad Hijazi1
1Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Insights
The biomarker-based ABC-AF stroke risk score effectively predicts stroke in atrial fibrillation (AF) patients. This score offers superior discrimination compared to traditional methods, aiding in stroke prevention decisions.
Area of Science:
- Cardiology
- Stroke Prevention
- Biomarker Research
Background:
- Stroke risk is a primary concern for patients with atrial fibrillation (AF).
- Current stroke prevention strategies rely heavily on risk assessment.
Purpose of the Study:
- To evaluate the biomarker-based Age, Biomarkers, Clinical history (ABC)-AF-stroke risk score.
- To develop a modified ABC-AF-istroke score for predicting total and ischemic stroke in AF patients.
Main Methods:
- Utilized data from 26,452 AF patients on direct oral anticoagulants or warfarin.
- Calculated ABC-AF-stroke and modified ABC-AF-istroke scores using age, clinical history, N-terminal pro B-type natriuretic peptide, and troponin levels.
Main Results:
- The ABC-AF-stroke score demonstrated superior discrimination for total stroke (C-index 0.667) and ischemic stroke (C-index 0.677) compared to ATRIA and CHA2DS2-VASc scores.
- Scores showed good calibration and consistent results across subgroups.
- Decision curve analyses indicated a net benefit for stroke prevention.
Conclusions:
- Biomarker-based ABC-AF risk scores are well-calibrated and outperform clinical scores in predicting stroke in AF patients.
- These scores provide valuable decision support for optimizing stroke prevention treatments.
Background:
In patients with atrial fibrillation (AF) the risk of ischemic stroke is central to recommendations for stroke-prevention treatment.
Objectives:
The authors evaluated the biomarker-based Age, Biomarkers, Clinical history (ABC)-AF-stroke risk score and developed a modified ABC-AF-istroke risk score for prediction of respectively total and ischemic stroke in patients with AF.
Methods:
In 26,452 patients with AF assigned to direct oral anticoagulants (DOACs) or warfarin, information on age, clinical history of stroke, and levels of N-terminal pro B-type natriuretic peptide and troponin were used for calculation of the ABC-AF-stroke score and the modified ABC-AF-istroke score.
Results:
During follow-up, there were 756 cases with stroke or systemic embolism (SEE) including 534 with ischemic stroke/SEE. The discrimination of total stroke/SEE was superior for the ABC-AF-stroke score, C-index (0.667 [95% CI: 0.648-0.687]), compared with 0.632 (95% CI: 0.612-0.652) for the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) and 0.614 (95% CI: 0.594-0.633) for the CHA2DS2-VASc score (P < 0.001 for both). The results were similar for ischemic stroke/SEE with C-index for ABC-AF-istroke 0.677 (95% CI: 0.654-0.700) compared with 0.642 (95% CI: 0.618-0.666) for the ATRIA and 0.624 (95% CI: 0.601-0.647) for the CHA2DS2-VASc score (P < 0.001 for both). The ABC-AF-stroke scores showed good calibration for total and ischemic stroke. Results were consistent in relevant subgroups. Decision curve analyses showed a net benefit concerning stroke-prevention decision thresholds.
Conclusions:
The biomarker-based ABC-AF risk scores for the risk of total and ischemic stroke were well calibrated, showed better discrimination than clinical risk scores in predicting total and ischemic stroke, and provided meaningful decision support for stroke-prevention treatments in patients with AF.
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