Identification of Markers Associated With Development of Stroke in "Clinically Low-Risk" Atrial Fibrillation Patients

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 YH ORCID: 0000-0002-7566-1626
et al (show 1 more authors) (2019) Identification of Markers Associated With Development of Stroke in "Clinically Low-Risk" Atrial Fibrillation Patients. JOURNAL OF THE AMERICAN HEART ASSOCIATION, 8 (21). e012697-.

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Background Stroke and thromboembolic events may still occur in "clinically low-risk" atrial fibrillation (AF) patients as categorized by CHA<sub>2</sub>DS<sub>2</sub>-VASc score. Our aim was to assess the proportion of "clinically low-risk" patients using a nongender CHA<sub>2</sub>DS<sub>2</sub>-VASc (ie, CHA<sub>2</sub>DS<sub>2</sub>-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<sub>2</sub>DS<sub>2</sub>-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<sub>2</sub>DS<sub>2</sub>-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; <i>P</i><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." Clinical Trial Registration URL: Unique identifier: NCT03147911.

Item Type: Article
Uncontrolled Keywords: ABCD score, atrial fibrillation, risk score, risk stratification, stroke, ischemic
Depositing User: Symplectic Admin
Date Deposited: 02 Dec 2019 14:00
Last Modified: 19 Jan 2023 00:17
DOI: 10.1161/JAHA.119.012697
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