Validation of Biomarker-Based ABCD Score in Atrial Fibrillation Patients with a Non-Gender CHA2DS2 -VASc Score 0–1: A Korean Multi-Center Cohort
- Author:
Moonki JUNG
1
;
Kyeongmin BYEON
;
Ki-Woon KANG
;
Yae Min PARK
;
You Mi HWANG
;
Sung Ho LEE
;
Eun-Sun JIN
;
Seung-Young ROH
;
Jin Seok KIM
;
Jinhee AHN
;
So-Ryoung LEE
;
Eue-Keun CHOI
;
Min-soo AHN
;
Eun Mi LEE
;
Hwan-Cheol PARK
;
Ki Hong LEE
;
Min KIM
;
Joon Hyouk CHOI
;
Jum Suk KO
;
Jin Bae KIM
;
Changsoo KIM
;
Gregory Y.H. LIP
;
Seung Yong SHIN
;
Author Information
- Publication Type:Original Article
- From:Yonsei Medical Journal 2022;63(10):892-901
- CountryRepublic of Korea
- Language:English
-
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-terminal 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 reclassification 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.
