The ABC (age, biomarkers, clinical history) stroke risk score: a biomarker-based risk score for predicting stroke in atrial fibrillation.
The ABC (age, biomarkers, clinical history) stroke risk score: a biomarker-based risk score for predicting stroke in atrial fibrillation.
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DOI：
10.1093/eurheartj/ehw054
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发表时间：
2016-05-21
影响因子：
39.3
通讯作者：
ARISTOTLE and STABILITY Investigators
中科院分区：
文献类型：
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作者：
Hijazi Z;Lindbäck J;Alexander JH;Hanna M;Held C;Hylek EM;Lopes RD;Oldgren J;Siegbahn A;Stewart RA;White HD;Granger CB;Wallentin L;ARISTOTLE and STABILITY Investigators
心房颤动(AF)与中风风险的增加有关，目前根据临床特征对此进行了估计。心脏生物标志物N末端片段B型利钠肽(NT-proBNP)和心肌肌钙蛋白高敏蛋白(cTn-hs)与房颤患者发生卒中的风险独立相关。我们的目标是开发和验证一种新的基于生物标记物的风险评分，以改善房颤患者卒中的预后。制定了一个新的风险评分，并在14701名房颤患者中进行了内部验证，这些患者在基线时确定了生物标志物水平，平均随访时间为1.9年。通过COX回归对预测中风或系统性血栓的生物标志物和临床变量进行评估，每个变量都获得了与模型系数成比例的权重。对1400例房颤患者进行了外部验证，中位随访时间为3.4年。最重要的预测因素是既往卒中/短暂性脑缺血发作、NT-proBNP、cTn-hs和年龄，这些因素包括在ABC(Age、B、C临床病史)卒中风险评分中。ABC-卒中评分经过了很好的校准，在派生队列(0.68vs.0.62，P<；0.001)和外部验证队列(0.66vs.0.58P<；0.001)中，c指数都高于广泛使用的CHA2DS2-VASC评分。此外，ABC中风评分在几个重要的亚组中持续提供较高的C指数。一种新的基于生物标记物的风险评分被成功地开发出来，用于预测房颤患者的卒中，并在大量房颤患者中进行了内部验证，并在独立的房颤队列中进一步进行了外部验证。ABC卒中评分优于目前临床使用的基于临床的风险评分，可为房颤患者提供更好的决策支持。NCT00412984、NCT00799903。
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 ( A ge, B iomarkers, C linical history) stroke risk score. The ABC-stroke score was well calibrated and yielded higher c-indices than the widely used CHA 2 DS 2 -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.