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The ABC (age, biomarkers, clinical history) stroke risk score: a biomarker-based risk score for predicting stroke in atrial fibrillation
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
Duke Med, Duke Clin Res Inst, Durham, NC USA..
Bristol Myers Squibb Co, Princeton, NJ USA..
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2016 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 37, no 20, 1582-1590 p.Article in journal (Refereed) PublishedText
Abstract [en]

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.

Place, publisher, year, edition, pages
2016. Vol. 37, no 20, 1582-1590 p.
Keyword [en]
Atrial fibrillation, Biomarkers, Natriuretic peptides, Risk score, Stroke, Troponin
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-298084DOI: 10.1093/eurheartj/ehw054ISI: 000376168100009PubMedID: 26920728OAI: oai:DiVA.org:uu-298084DiVA: diva2:944603
Funder
Swedish Foundation for Strategic Research GlaxoSmithKline (GSK)
Available from: 2016-06-29 Created: 2016-06-29 Last updated: 2016-06-29Bibliographically approved

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Hijazi, ZiadLindbäck, JohanHeld, ClaesOldgren, JonasSiegbahn, AgnetaWallentin, Lars
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CardiologyUCR-Uppsala Clinical Research CenterDepartment of Medical Sciences
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European Heart Journal
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