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

被引：347

作者：

Hijazi, Ziad ^{[1
,2
]}

Lindback, Johan ^{[2
]}

Alexander, John H. ^{[3
]}

Hanna, Michael ^{[4
]}

Held, Claes ^{[1
,2
]}

Hylek, Elaine M. ^{[5
]}

Lopes, Renato D. ^{[3
]}

Oldgren, Jonas ^{[1
,2
]}

Siegbahn, Agneta ^{[2
,6
]}

Stewart, Ralph A. H. ^{[7
,8
]}

White, Harvey D. ^{[7
,8
]}

Granger, Christopher B. ^{[3
]}

Wallentin, Lars ^{[1
,2
]}

机构：

[1] Uppsala Univ, Cardiol, Dept Med Sci, Uppsala, Sweden

[2] Uppsala Univ, Uppsala Clin Res Ctr, Uppsala Sci Pk, Uppsala, Sweden

[3] Duke Med, Duke Clin Res Inst, Durham, NC USA

[4] Bristol Myers Squibb Co, Princeton, NJ USA

[5] Boston Univ, Med Ctr, Boston, MA USA

[6] Uppsala Univ, Dept Med Sci, Clin Chem, Uppsala, Sweden

[7] Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand

[8] Univ Auckland, Auckland 1, New Zealand

来源：

EUROPEAN HEART JOURNAL | 2016年 / 37卷 / 20期

关键词：

Atrial fibrillation; Biomarkers; Natriuretic peptides; Risk score; Stroke; Troponin; THROMBOEMBOLIC EVENTS; NATRIURETIC PEPTIDE; CARDIAC BIOMARKERS; APIXABAN; THERAPY; ANTICOAGULATION; STRATIFICATION; REDUCTION; INSIGHTS; VALIDATION;

D O I：

10.1093/eurheartj/ehw054

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1582 / 1590

页数：9

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