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New risk score outperforms existing score for prediction of stroke in patients with AF
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A novel biomarker-based risk score outperformed the most popular risk score for predicting stroke in patients with atrial fibrillation, according to new findings.
Current risk scores, including the most commonly used CHA2DS2-VASc score, are based on clinical characteristics, but the researchers developed a score incorporating the biomarkers N-terminal pro–B-type natriuretic peptide and high-sensitivity cardiac troponin, which have been independently associated with elevated stroke risk in patients with AF.
Ziad Hijazi, MD, and colleagues developed the ABC (age, biomarkers, clinical history) stroke risk score, which consists of four variables: age, NT-proBNP, high-sensitivity cardiac troponin I or T, and prior stroke or transient ischemic attack.
They developed it in a cohort of 14,701 patients from the ARISTOTLE trial for whom biomarker information was available and who were followed for a median of 1.9 years. There were 391 cases of stroke or systemic embolism during 27,929 person-years of follow-up, they reported.
In that population, those four variables were the strongest predictors of stroke, and other clinical variables and biomarkers did not add sufficient information to the score, Hijazi, from the department of medical sciences, cardiology, and the Uppsala Clinical Research Center, Uppsala University, Sweden, and colleagues wrote.
In internal validation, the ABC-stroke score had a C-statistic of 0.68 for stroke or systemic embolism vs. 0.62 for the CHA2DS2-VASc score (P < .001), they wrote.
The researchers then externally validated the score in 1,400 people with AF or atrial flutter from the STABILITY trial.
During 4,751 person-years of follow-up that included 48 stroke events, the ABC-stroke score had a C-statistic of 0.66 vs. 0.58 for the CHA2DS2-VASc score (P < .001), according to the researchers.
“The biomarkers appear to add important information concerning subclinical [CV] dysfunction and were better associated with vascular vulnerability than disease diagnosis,” Hijazi and colleagues wrote. “The ABC-stroke risk score consistently performed better than presently used clinically based risk scores in terms of risk prediction and risk stratification, and may provide improved decision support in patients with AF.” – by Erik Swain
Disclosure: The ARISTOTLE trial was funded by Bristol-Myers Squibb and Pfizer. The STABILITY trial was funded by GlaxoSmithKline. Hijazi reports receiving institutional research grants from Bristol-Myers Squibb/Pfizer and institutional research grants and lecture fees from Boehringer Ingelheim. Please see the full study for a list of the other researchers’ relevant financial disclosures.
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