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

Autor: Niederdöckl J; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria., Oppenauer J; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria., Schnaubelt S; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria., Cacioppo F; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria., Buchtele N; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.; Department of Medicine I, Medical University of Vienna, Vienna, Austria., Warenits AM; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria., Laggner R; Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria., Schütz N; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria., Bögl MS; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria., Ruzicka G; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria., Gupta S; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria., Lutnik M; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria., Sheikh Rezaei S; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria., Wolzt M; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria., Herkner H; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria., Domanovits H; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria., Laggner AN; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria., Schwameis M; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria., Hijazi Z; Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Jazyk: angličtina
Zdroj: Frontiers in medicine [Front Med (Lausanne)] 2022 Jun 27; Vol. 9, pp. 830580. Date of Electronic Publication: 2022 Jun 27 (Print Publication: 2022).
DOI: 10.3389/fmed.2022.830580
Abstrakt: 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.
Competing Interests: ZH reports personal fees from Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer and Roche Diagnostics for lectures, personal fees from Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, and Roche Diagnostics for consulting, and grants from the Swedish Society for Medical Research (S17-0133) and the Swedish Heart-Lung Foundation (20170718), outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2022 Niederdöckl, Oppenauer, Schnaubelt, Cacioppo, Buchtele, Warenits, Laggner, Schütz, Bögl, Ruzicka, Gupta, Lutnik, Sheikh Rezaei, Wolzt, Herkner, Domanovits, Laggner, Schwameis and Hijazi.)
Databáze: MEDLINE
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