The ABC-Stroke Score Refines Stroke Risk Stratification in Patients With Atrial Fibrillation at the Emergency Department
FRONTIERS IN MEDICINE(2022)
摘要
AimsTo 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 ResultsThe 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. ConclusionIn 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.
更多查看译文
关键词
symptomatic atrial fibrillation, stroke, prediction score, performance evaluation, validation, biomarkers
AI 理解论文
溯源树
样例
生成溯源树,研究论文发展脉络
Chat Paper
正在生成论文摘要