Dataset Information

Validation of Biomarker-Based ABCD Score in Atrial Fibrillation Patients with a Non-Gender CHA₂DS₂-VASc Score 0-1: A Korean Multi-Center Cohort.

ABSTRACT:

Purpose

Atrial fibrillation (AF) patients with low to intermediate risk, defined as non-gender CHA₂DS₂-VASc score of 0-1, are still at risk of stroke. This study verified the usefulness of ABCD score [age (≥60 years), B-type natriuretic peptide (BNP) or N-terminal pro-BNP (≥300 pg/mL), creatinine clearance (<50 mL/min/1.73 m²), and dimension of the left atrium (≥45 mm)] for stroke risk stratification in non-gender CHA₂DS₂-VASc score 0-1.

Materials and methods

This multi-center cohort study retrospectively analyzed AF patients with non-gender CHA₂DS₂-VASc score 0-1. The primary endpoint was the incidence of stroke with or without antithrombotic therapy (ATT). An ABCD score was validated.

Results

Overall, 2694 patients [56.3±9.5 years; female, 726 (26.9%)] were followed-up for 4.0±2.8 years. The overall stroke rate was 0.84/100 person-years (P-Y), stratified as follows: 0.46/100 P-Y for an ABCD score of 0; 1.02/100 P-Y for an ABCD score ≥1. The ABCD score was superior to non-gender CHA₂DS₂-VASc score in the stroke risk stratification (C-index=0.618, p=0.015; net reclassification improvement=0.576, p=0.040; integrated differential improvement=0.033, p=0.066). ATT was prescribed in 2353 patients (86.5%), and the stroke rate was significantly lower in patients receiving non-vitamin K antagonist oral anticoagulant (NOAC) therapy and an ABCD score ≥1 than in those without ATT (0.44/100 P-Y vs. 1.55/100 P-Y; hazard ratio=0.26, 95% confidence interval 0.11-0.63, p=0.003).

Conclusion

The biomarker-based ABCD score demonstrated improved stroke risk stratification in AF patients with non-gender CHA₂DS₂-VASc score 0-1. Furthermore, NOAC with an ABCD score ≥1 was associated with significantly lower stroke rate in AF patients with non-gender CHA₂DS₂-VASc score 0-1.

SUBMITTER: Jung M

PROVIDER: S-EPMC9520051 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Publications

Validation of Biomarker-Based ABCD Score in Atrial Fibrillation Patients with a Non-Gender CHA<sub>2</sub>DS<sub>2</sub>-VASc Score 0-1: A Korean Multi-Center Cohort.

Jung Moonki M Byeon Kyeongmin K Kang Ki-Woon KW Park Yae Min YM Hwang You Mi YM Lee Sung Ho SH Jin Eun-Sun ES Roh Seung-Young SY Kim Jin Seok JS Ahn Jinhee J Lee So-Ryoung SR Choi Eue-Keun EK Ahn Min-Soo MS Lee Eun Mi EM Park Hwan-Cheol HC Lee Ki Hong KH Kim Min M Choi Joon Hyouk JH Ko Jum Suk JS Kim Jin Bae JB Kim Changsoo C Lip Gregory Y H GYH Shin Seung Yong SY

Yonsei medical journal 20221001 10

<h4>Purpose</h4>Atrial fibrillation (AF) patients with low to intermediate risk, defined as non-gender CHA<sub>2</sub>DS<sub>2</sub>-VASc score of 0-1, are still at risk of stroke. This study verified the usefulness of ABCD score [age (≥60 years), B-type natriuretic peptide (BNP) or N-terminal pro-BNP (≥300 pg/mL), creatinine clearance (<50 mL/min/1.73 m²), and dimension of the left atrium (≥45 mm)] for stroke risk stratification in non-gender CHA<sub>2</sub>DS<sub>2</sub>-VASc score 0-1.<h4>Mat ...[more]

PMID: 36168241

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Project description:Background and Purpose- Despite modest predictive ability for ischemic stroke (IS), the CHA2DS2-VASc score is widely used for stroke prediction in atrial fibrillation. Among patients with atrial fibrillation, we aimed to (1) compare the IS or transient ischemic attack (TIA) incidence by CHA2DS2-VASc in blacks and Hispanics versus whites; (2) compare predictive ability of CHA2DS2-VASc score for IS or TIA in blacks and Hispanics versus whites; and (3) determine improvement in predictive ability of CHA2DS2-VASc score from addition of race/ethnicity. Methods- Using data from Optum Clinformatics, a large administrative claims database, we analyzed patients with atrial fibrillation enrolled in commercial and Medicare Advantage health plans from 2009 to 2015. We computed IS or TIA incidence rates, improvement in C statistic, continuous and categorical net reclassification improvement, and relative integrated discrimination improvement from addition of race/ethnicity to CHA2DS2-VASc. Results- A total of 267 419 patients (mean age, 73.1 [SD, 12.3] years; 46.6% women; 84.2% white, 8.5% black, 7.3% Hispanic) were studied. After a mean follow-up of 22 months, there were 6202 IS or TIA events. IS or TIA incidence rates were higher in blacks than Hispanics or whites (1.65, 1.40, and 1.22 cases per 100 person-years, respectively) and increased with higher CHA2DS2-VASc, with no race/ethnicity-based differences (P for interaction=0.17). The CHA2DS2-VASc and CHA2DS2-VASc+race/ethnicity C statistic (95% CI) were 0.679 (0.670-0.686) and 0.679 (0.671-0.688). The CHA2DS2-VASc C statistic in the 3 groups were comparable. With addition of race/ethnicity, the categorical net reclassification improvement, continuous net reclassification improvement, and relative integrated discrimination improvement were -0.045 (95% CI, -0.067 to -0.025), 0.045 (95% CI, 0.025-0.068), and 0.016 (95% CI, 0.014-0.018). Conclusions- The predictive ability of CHA2DS2-VASc for IS or TIA in atrial fibrillation is comparable among whites, blacks, and Hispanics; hence, it can be used in the latter 2 groups. Addition of race/ethnicity to the CHA2DS2-VASc does not improve its predictive ability.

Project description:BackgroundIn people with atrial fibrillation (AF), periods of sinus rhythm present an opportunity to detect prothrombotic atrial remodeling through measurement of P-wave indices (PWIs)-prolonged P-wave duration, abnormal P-wave axis, advanced interatrial block, and abnormal P-wave terminal force in lead V1. We hypothesized that the addition of PWIs to the CHA2DS2-VASc score would improve its ability to predict AF-related ischemic stroke.MethodsWe included 2229 participants from the ARIC study (Atherosclerosis Risk in Communities) and 700 participants from MESA (Multi-Ethnic Study of Atherosclerosis) with incident AF who were not on anticoagulants within 1 year of AF diagnosis. PWIs were obtained from study visit ECGs before development of AF. AF was ascertained using study visit ECGs and hospital records. Ischemic stroke cases were based on physician adjudication of hospital records. We used Cox proportional hazards models to estimate hazard ratios and 95% CIs of PWIs for ischemic stroke. Improvement in 1-year stroke prediction was assessed by C-statistic, categorical net reclassification improvement, and relative integrated discrimination improvement.ResultsAbnormal P-wave axis was the only PWI associated with increased ischemic stroke risk (hazard ratio, 1.84; 95% CI, 1.33-2.55) independent of CHA2DS2-VASc variables, and that resulted in meaningful improvement in stroke prediction. The β estimate was approximately twice that of the CHA2DS2-VASc variables, and thus abnormal P-wave axis was assigned 2 points to create the P2-CHA2DS2-VASc score. This improved the C-statistic (95% CI) from 0.60 (0.51-0.69) to 0.67 (0.60-0.75) in ARIC and 0.68 (0.52-0.84) to 0.75 (0.60-0.91) in MESA (validation cohort). In ARIC and MESA, the categorical net reclassification improvements (95% CI) were 0.25 (0.13-0.39) and 0.51 (0.18-0.86), respectively, and the relative integrated discrimination improvement (95% CI) were 1.19 (0.96-1.44) and 0.82 (0.36-1.39), respectively.ConclusionsAbnormal P-wave axis-an ECG correlate of left atrial abnormality- improves ischemic stroke prediction in AF. Compared with CHA2DS2-VASc, the P2-CHA2DS2-VASc is a better prediction tool for AF-related ischemic stroke.

Dataset Information

Validation of Biomarker-Based ABCD Score in Atrial Fibrillation Patients with a Non-Gender CHA₂DS₂-VASc Score 0-1: A Korean Multi-Center Cohort.

Purpose

Materials and methods

Results

Conclusion

Publications

Validation of Biomarker-Based ABCD Score in Atrial Fibrillation Patients with a Non-Gender CHA<sub>2</sub>DS<sub>2</sub>-VASc Score 0-1: A Korean Multi-Center Cohort.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

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Dataset Information

Validation of Biomarker-Based ABCD Score in Atrial Fibrillation Patients with a Non-Gender CHA2DS2-VASc Score 0-1: A Korean Multi-Center Cohort.

Purpose

Materials and methods

Results

Conclusion

Publications

Validation of Biomarker-Based ABCD Score in Atrial Fibrillation Patients with a Non-Gender CHA<sub>2</sub>DS<sub>2</sub>-VASc Score 0-1: A Korean Multi-Center Cohort.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Validation of Biomarker-Based ABCD Score in Atrial Fibrillation Patients with a Non-Gender CHA₂DS₂-VASc Score 0-1: A Korean Multi-Center Cohort.