Int J Arrhythm.  2020 Sep;21(3):e10. 10.1186/s42444-020-00018-4.

Prognostic value of routine blood tests along with clinical risk factors in predicting ischemic stroke in non‑valvular atrial fibrillation: a prospective cohort study

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak‑ro, Jongno‑gu, Seoul 03080, Republic of Korea

Abstract

Background
In patients with atrial fibrillation (AF), most biomarkers are still of limited use due to cost-effectiveness and complexity in clinical practice.
Hypotheses
Biomarkers from routine blood tests improve the current risk stratification in AF patients.
Methods
This prospective study enrolled 600 patients diagnosed with non-valvular AF, of whom 537 were analyzed. Platelet count; platelet distribution width (PDW); red cell distribution width (RDW); and creatinine, D-dimer, and troponin I levels were measured at enrollment.
Results
During the mean follow-up period (2.2 ± 0.6 years), 1.9% patients developed ischemic stroke. According to the optimal cutoff of each biomarker, the risk of ischemic stroke was higher in patients with RDW ≥ 13.5%, creatinine ≥ 1.11 mg/dL, or PDW ≥ 13.2% (significant biomarkers; P value: < 0.01, 0.04, or 0.07, respectively). These 3 significant biomarkers had higher information gain than clinical risk factors in predicting ischemic stroke. The cumulative incidence of ischemic stroke was 1.2%, 1.1%, 8.4%, and 40.0% in patients with 0, 1, 2, and 3 significant biomarkers, respectively (P-for-trend < 0.001). Patients with  ≥ 2 significant biomarkers had a significantly higher risk of ischemic stroke than those with  < 2 significant biomarkers (adjusted hazard ratio 11.5, 95% confidence interval 3.3–40.2, P < 0.001). The predictability for ischemic stroke was significantly improved when  ≥ 2 significant biomarkers were added to the CHA2DS2–VASc score (area under the curve 0.790 vs. 0.620, P = 0.043).
Conclusion
Routine blood tests can provide better risk stratification of AF along with clinical risk factors.

Keyword

Atrial fibrillation; Biomarkers; Stroke; Thromboembolism
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