Yonsei Med J.  2022 Oct;63(10):892-901. 10.3349/ymj.2022.0157.

Validation of Biomarker-Based ABCD Score in Atrial Fibrillation Patients with a Non-Gender CHA2DS2 -VASc Score 0–1: A Korean Multi-Center Cohort

Affiliations
  • 1Department of Cardiology, Heart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, Gwangmyeong, Korea
  • 2Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
  • 3Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
  • 4Division of Cardiology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
  • 5Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 6Cardiovascular Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
  • 7Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
  • 8Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
  • 9Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
  • 10Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju College of Medicine, Wonju, Korea
  • 11Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Korea
  • 12Department of Cardiology, Hanyang University Guri Hospital, Guri, Korea
  • 13Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
  • 14Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
  • 15Division of Cardiology, Department of Internal Medicine, School of Medicine, Jeju National University, Jeju National University Hospital, Jeju, Korea
  • 16Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
  • 17Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea
  • 18Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 19Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
  • 20Department of Clinical Medicine, Aalborg University, Denmark

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.

Keyword

Atrial fibrillation; risk stratification; stroke; ABCD score
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