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

• Published in: European heart journal Vol. 37; no. 20; pp. 1582 - 1590
• Main Authors: Hijazi, Ziad, Lindbäck, Johan, Alexander, John H, Hanna, Michael, Held, Claes, Hylek, Elaine M, Lopes, Renato D, Oldgren, Jonas, Siegbahn, Agneta, Stewart, Ralph A H, White, Harvey D, Granger, Christopher B, Wallentin, Lars
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 21.05.2016
• Subjects: Atrial Fibrillation; Biomarkers; Clinical Research; Editor's Choice; Humans; Medical History Taking; Natriuretic Peptide, Brain; Natriuretic peptides; Risk Assessment; Risk Factors; Risk score; Stroke; Troponin; Biomarkers; Risk score; Stroke; Troponin; Atrial fibrillation; Natriuretic peptides
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehw054

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. 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. 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. NCT00412984, NCT00799903.