MAPH score improves stroke risk prediction in paroxysmal atrial fibrillation: a comparison with CHA₂DS₂-VASc

Paroxysmal atrial fibrillation (PAF) increases the risk of ischemic stroke. The CHA₂DS₂-VASc score is commonly used for stroke risk assessment but has some limitations in low-risk individuals. The MAPH score has been suggested as a simple predictor of thrombotic events in patients with myocardial infarction, although its effectiveness in patients with PAF remains uncertain. This study aimed to compare the predictive performance of the MAPH score and the CHA₂DS₂-VASc-M score for ischemic stroke in patients with PAF.

This retrospective study included 474 patients (253 with ischemic stroke and 221 without stroke) between January 2023 and July 2025. The MAPH score was calculated using mean platelet volume (MPV), age, total protein, and hematocrit (HCT). Age was excluded from the MAPH score when creating CHA₂DS₂-VASc-M to avoid redundancy. Receiver operating characteristic (ROC) analysis and logistic regression were used to evaluate predictive performance.

MPV, total protein, HCT, and MAPH scores were significantly higher in patients with stroke (p < 0.001 for all). ROC analysis showed that the MAPH score had an area under the curve (AUC) of 0.706, CHA₂DS₂-VASc 0.595, and CHA₂DS₂-VASc-M 0.667. In low-risk patients (CHA₂DS₂-VASc ≤1), MAPH (AUC 0.719) and CHA₂DS₂-VASc-M (AUC 0.711) performed better than CHA₂DS₂-VASc alone (AUC 0.510). Multivariate logistic regression identified MAPH, CHA₂DS₂-VASc-M, MPV, total protein, and HCT as independent predictors of ischemic stroke.

The MAPH score, whether used independently or alongside CHA₂DS₂-VASc, enhances the prediction of ischemic stroke among patients with PAF, especially in low-risk groups. Including MAPH in standard risk evaluations could improve decisions regarding anticoagulant therapy.