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

Authors :
Jung M
Byeon K
Kang KW
Park YM
Hwang YM
Lee SH
Jin ES
Roh SY
Kim JS
Ahn J
Lee SR
Choi EK
Ahn MS
Lee EM
Park HC
Lee KH
Kim M
Choi JH
Ko JS
Kim JB
Kim C
Lip GYH
Shin SY
Source :
Yonsei medical journal [Yonsei Med J] 2022 Oct; Vol. 63 (10), pp. 892-901.
Publication Year :
2022

Abstract

Purpose: Atrial fibrillation (AF) patients with low to intermediate risk, defined as non-gender CHA <subscript>2</subscript> DS <subscript>2</subscript> -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 <subscript>2</subscript> DS <subscript>2</subscript> -VASc score 0-1.<br />Materials and Methods: This multi-center cohort study retrospectively analyzed AF patients with non-gender CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score 0-1. The primary endpoint was the incidence of stroke with or without antithrombotic therapy (ATT). An ABCD score was validated.<br />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 CHA <subscript>2</subscript> DS <subscript>2</subscript> -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).<br />Conclusion: The biomarker-based ABCD score demonstrated improved stroke risk stratification in AF patients with non-gender CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score 0-1. Furthermore, NOAC with an ABCD score ≥1 was associated with significantly lower stroke rate in AF patients with non-gender CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score 0-1.<br />Competing Interests: The authors have no potential conflicts of interest to disclose.<br /> (© Copyright: Yonsei University College of Medicine 2022.)

Details

Language :
English
ISSN :
1976-2437
Volume :
63
Issue :
10
Database :
MEDLINE
Journal :
Yonsei medical journal
Publication Type :
Academic Journal
Accession number :
36168241
Full Text :
https://doi.org/10.3349/ymj.2022.0157