Validation of Biomarker-Based ABCD Score in Atrial Fibrillation Patients with a Non-Gender CHA2DS2-VASc Score 0–1: A Korean Multi-Center Cohortopen access
- Authors
- Jung, Moonki; Byeon, Kyeongmin; Kang, K.-W.; Park, Y.M.; Hwang, Y.M.; Lee, S.H.; Jin, E.-S.; Roh, S.-Y.; Kim, J.S.; Ahn, J.; Lee, S.-R.; Choi, E.-K.; Ahn, M.-S.; Lee, E.M.; Park, H.-C.; Lee, K.H.; Kim, M.; Choi, J.H.; Ko, J.S.; Kim, J.B.; Kim, C.; Lip, G.Y.H.; Shin, Seung Yong
- Issue Date
- Oct-2022
- Publisher
- Yonsei University College of Medicine
- Keywords
- ABCD score; Atrial fibrillation; risk stratification; stroke
- Citation
- Yonsei Medical Journal, v.63, no.10, pp 892 - 901
- Pages
- 10
- Journal Title
- Yonsei Medical Journal
- Volume
- 63
- Number
- 10
- Start Page
- 892
- End Page
- 901
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/72429
- DOI
- 10.3349/ymj.2022.0157
- ISSN
- 0513-5796
1976-2437
- Abstract
- Purpose: Atrial fibrillation (AF) patients with low to intermediate risk, defined as non-gender CHA2DS2-VASc score of 0–1, are still at risk of stroke. This study verified the usefulness of ABCD score [age (≥60 years), B-type natriuretic peptide (BNP) or N-ter-minal pro-BNP (≥300 pg/mL), creatinine clearance (<50 mL/min/1.73 m2), and dimension of the left atrium (≥45 mm)] for stroke risk stratification in non-gender CHA2DS2-VASc score 0–1. Materials and Methods: This multi-center cohort study retrospectively analyzed AF patients with non-gender CHA2DS2-VASc score 0–1. The primary endpoint was the incidence of stroke with or without antithrombotic therapy (ATT). An ABCD score was validated. Results: Overall, 2694 patients [56.3±9.5 years; female, 726 (26.9%)] were followed-up for 4.0±2.8 years. The overall stroke rate was 0.84/100 person-years (P-Y), stratified as follows: 0.46/100 P-Y for an ABCD score of 0; 1.02/100 P-Y for an ABCD score ≥1. The ABCD score was superior to non-gender CHA2DS2-VASc score in the stroke risk stratification (C-index=0.618, p=0.015; net reclassi-fication improvement=0.576, p=0.040; integrated differential improvement=0.033, p=0.066). ATT was prescribed in 2353 patients (86.5%), and the stroke rate was significantly lower in patients receiving non-vitamin K antagonist oral anticoagulant (NOAC) therapy and an ABCD score ≥1 than in those without ATT (0.44/100 P–Y vs. 1.55/100 P-Y; hazard ratio=0.26, 95% confidence interval 0.11–0.63, p=0.003). Conclusion: The biomarker-based ABCD score demonstrated improved stroke risk stratification in AF patients with non-gender CHA2DS2-VASc score 0–1. Furthermore, NOAC with an ABCD score ≥1 was associated with significantly lower stroke rate in AF patients with non-gender CHA2DS2-VASc score 0–1. © Yonsei University College of Medicine 2022.
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