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Eur Heart J. 2016 May 21;37(20):1582-90. doi: 10.1093/eurheartj/ehw054. Epub 2016 Feb 25.

The ABC (age, biomarkers, clinical history) stroke risk score: a biomarker-based risk score for predicting stroke in atrial fibrillation.

Author information

1
Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala University, Uppsala Science Park, Uppsala, Sweden ziad.hijazi@ucr.uu.se.
2
Uppsala Clinical Research Center, Uppsala University, Uppsala Science Park, Uppsala, Sweden.
3
Duke Clinical Research Institute, Duke Medicine, Durham, NC, USA.
4
Bristol-Myers Squibb, Princeton, NJ, USA.
5
Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala University, Uppsala Science Park, Uppsala, Sweden.
6
Boston University Medical Center, Boston, MA, USA.
7
Uppsala Clinical Research Center, Uppsala University, Uppsala Science Park, Uppsala, Sweden Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden.
8
Green Lane Cardiovascular Service, Auckland City Hospital and University of Auckland, Auckland, New Zealand.

Abstract

AIMS:

Atrial fibrillation (AF) is associated with an increased risk of stroke, which is currently estimated by clinical characteristics. The cardiac biomarkers N-terminal fragment B-type natriuretic peptide (NT-proBNP) and cardiac troponin high-sensitivity (cTn-hs) are independently associated with risk of stroke in AF. Our objective was to develop and validate a new biomarker-based risk score to improve prognostication of stroke in patients with AF.

METHODS AND RESULTS:

A new risk score was developed and internally validated in 14 701 patients with AF and biomarkers levels determined at baseline, median follow-up of 1.9 years. Biomarkers and clinical variables significantly contributing to predicting stroke or systemic embolism were assessed by Cox-regression and each variable obtained a weight proportional to the model coefficients. External validation was performed in 1400 patients with AF, median follow-up of 3.4 years. The most important predictors were prior stroke/transient ischaemic attack, NT-proBNP, cTn-hs, and age, which were included in the ABC (Age, Biomarkers, Clinical history) stroke risk score. The ABC-stroke score was well calibrated and yielded higher c-indices than the widely used CHA2DS2-VASc score in both the derivation cohort (0.68 vs. 0.62, P < 0.001) and the external validation cohort (0.66 vs. 0.58, P < 0.001). Moreover, the ABC-stroke score consistently provided higher c-indices in several important subgroups.

CONCLUSION:

A novel biomarker-based risk score for predicting stroke in AF was successfully developed and internally validated in a large cohort of patients with AF and further externally validated in an independent AF cohort. The ABC-stroke score performed better than the presently used clinically based risk score and may provide improved decision support in AF.

CLINICALTRIALS GOV IDENTIFIER:

NCT00412984, NCT00799903.

KEYWORDS:

Atrial fibrillation; Biomarkers; Natriuretic peptides; Risk score; Stroke; Troponin

PMID:
26920728
PMCID:
PMC4875560
DOI:
10.1093/eurheartj/ehw054
[Indexed for MEDLINE]
Free PMC Article

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