Identification of Markers Associated With Development of Stroke in "Clinically Low-Risk" Atrial Fibrillation Patients
- Authors
- Shin, Seung Yong; Han, Sang-Jin; Kim, Jin-Seok; Im, Sung Il; Shim, Jaemin; Ahn, Jinhee; Lee, Eun Mi; Park, Yae Min; Kim, Jun Hyung; Lip, Gregory Y. H.; Lim, Hong Euy
- Issue Date
- 5-Nov-2019
- Publisher
- WILEY
- Keywords
- ABCD score; atrial fibrillation; risk score; risk stratification; stroke, ischemic
- Citation
- JOURNAL OF THE AMERICAN HEART ASSOCIATION, v.8, no.21
- Journal Title
- JOURNAL OF THE AMERICAN HEART ASSOCIATION
- Volume
- 8
- Number
- 21
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/17953
- DOI
- 10.1161/JAHA.119.012697
- ISSN
- 2047-9980
- Abstract
- Background-Stroke and thromboembolic events may still occur in "clinically low-risk" atrial fibrillation (AF) patients as categorized by CHA(2)DS(2)-VASc score. Our aim was to assess the proportion of "clinically low-risk" patients using a nongender CHA(2)DS(2)-VASc (ie, CHA(2)DS(2)-VA) score of 0 to 1 among patients who experienced AF-associated stroke and to identify markers associated with stroke in "clinically low-risk" patients. Methods and Results-We retrospectively recruited nonvalvular AF patients who experienced embolic stroke between 2013 and 2016 from 9 institutes in Korea. AF patients with CHA(2)DS(2)-VA score of 0 to 1 at the time of stroke were analyzed and compared with "clinically low-risk" AF patients without stroke. A total of 3033 subjects with AF-associated stroke were recruited. Of these, 583 patients (19.2%) had CHA(2)DS(2)-VA score of 0 to 1. On multivariate analysis, age (>= 60 years), N-terminal pro B-type natriuretic peptide (>= 300 pg/mL), creatinine clearance (<50 mL/min), and left atrial dimension (>= 45 mm) were independently associated with stroke. With the combined application of these 4 factors (collectively, ABCD score) to the "clinically low-risk" patients, the c-index was 0.858 (95% CI 0.838-0.877; P<0.001). Conclusions-The present study suggests a new insight into how additional use of markers can further refine stroke risk differentiation among AF patients initially classified as "clinically low-risk.
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