The ABC-Stroke Score Refines Stroke Risk Stratification in Patients With Atrial Fibrillation at the Emergency Department

Frontiers in Medicine

article

Jan Niederdöckl¹  Julia Oppenauer¹  Sebastian Schnaubelt¹  Filippo Cacioppo¹  Nina Buchtele²  Alexandra-Maria Warenits¹  Roberta Laggner⁴  Nikola Schütz¹  Magdalena S. Bögl¹  Gerhard Ruzicka¹  Sophie Gupta¹  Martin Lutnik¹  Safoura Sheikh Rezaei²  Michael Wolzt²  Harald Herkner¹  Hans Domanovits¹  Anton N. Laggner¹  Michael Schwameis¹  Ziad Hijazi⁵ 

[1] Department of Emergency Medicine, Medical University of Vienna;Department of Clinical Pharmacology, Medical University of Vienna;Department of Medicine I, Medical University of Vienna;Department of Orthopedics and Trauma-Surgery, Medical University of Vienna;Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University

关键词: symptomatic atrial fibrillation;    stroke;    prediction score;    performance evaluation;    validation;    biomarkers;   

DOI  :  10.3389/fmed.2022.830580

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Aims To evaluate the performance of the ABC (Age, Biomarkers, Clinical history) and CHA 2 DS 2 -VASc stroke scores under real-world conditions in an emergency setting. Methods and Results The performance of the biomarker-based ABC-stroke score and the clinical variable-based CHA 2 DS 2 -VASc score for stroke risk assessment were prospectively evaluated in a consecutive series of 2,108 patients with acute symptomatic atrial fibrillation at a tertiary care emergency department. Performance was assessed according to methods for the development and validation of clinical prediction models by Steyerberg et al. and the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis. During a cumulative observation period of 3,686 person-years, the stroke incidence rate was 1.66 per 100 person-years. Overall, the ABC-stroke and CHA 2 DS 2 -VASc scores revealed respective c-indices of 0.64 and 0.55 for stroke prediction. Risk-class hazard ratios comparing moderate to low and high to low were 3.51 and 2.56 for the ABC-stroke score and 1.10 and 1.62 for the CHA 2 DS 2 -VASc score. The ABC-stroke score also provided improved risk stratification in patients with moderate stroke risk according to the CHA 2 DS 2 -VASc score, who lack clear recommendations regarding anticoagulation therapy (HR: 4.35, P = 0.001). Decision curve analysis indicated a superior net clinical benefit of using the ABC-stroke score. Conclusion In a large, real-world cohort of patients with acute atrial fibrillation in the emergency department, the ABC-stroke score was superior to the guideline-recommended CHA 2 DS 2 -VASc score at predicting stroke risk and refined risk stratification of patients labeled moderate risk by the CHA 2 DS 2 -VASc score, potentially easing treatment decision-making.

【 授权许可】

CC BY