Biomarker-Based Model for Prediction of Ischemic Stroke in Patients With Atrial Fibrillation
- PMID: 40107814
- DOI: 10.1016/j.jacc.2024.11.052
Biomarker-Based Model for Prediction of Ischemic Stroke in Patients With Atrial Fibrillation
Abstract
Background: In patients with atrial fibrillation (AF) the risk of ischemic stroke is central to recommendations for stroke-prevention treatment.
Objectives: The authors evaluated the biomarker-based Age, Biomarkers, Clinical history (ABC)-AF-stroke risk score and developed a modified ABC-AF-istroke risk score for prediction of respectively total and ischemic stroke in patients with AF.
Methods: In 26,452 patients with AF assigned to direct oral anticoagulants (DOACs) or warfarin, information on age, clinical history of stroke, and levels of N-terminal pro B-type natriuretic peptide and troponin were used for calculation of the ABC-AF-stroke score and the modified ABC-AF-istroke score.
Results: During follow-up, there were 756 cases with stroke or systemic embolism (SEE) including 534 with ischemic stroke/SEE. The discrimination of total stroke/SEE was superior for the ABC-AF-stroke score, C-index (0.667 [95% CI: 0.648-0.687]), compared with 0.632 (95% CI: 0.612-0.652) for the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) and 0.614 (95% CI: 0.594-0.633) for the CHA2DS2-VASc score (P < 0.001 for both). The results were similar for ischemic stroke/SEE with C-index for ABC-AF-istroke 0.677 (95% CI: 0.654-0.700) compared with 0.642 (95% CI: 0.618-0.666) for the ATRIA and 0.624 (95% CI: 0.601-0.647) for the CHA2DS2-VASc score (P < 0.001 for both). The ABC-AF-stroke scores showed good calibration for total and ischemic stroke. Results were consistent in relevant subgroups. Decision curve analyses showed a net benefit concerning stroke-prevention decision thresholds.
Conclusions: The biomarker-based ABC-AF risk scores for the risk of total and ischemic stroke were well calibrated, showed better discrimination than clinical risk scores in predicting total and ischemic stroke, and provided meaningful decision support for stroke-prevention treatments in patients with AF.
Keywords: NT-proBNP; atrial fibrillation; biomarkers; stroke; troponin.
Copyright © 2025. Published by Elsevier Inc.
Conflict of interest statement
Funding Support and Author Disclosures RE-LY was funded by Boehringer Ingelheim. ARISTOTLE was funded by Bristol Myers Squibb and Pfizer. ENGAGE AF-TIMI 48 was funded by Daiichi-Sankyo. No outside funding was obtained to support the creation of the COMBINE AF database or for these analyses. Dr Wallentin has received grants from AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Pfizer, GlaxoSmithKline, Merck & Co, and Roche Diagnostics. Mr Lindbäck has received institutional research grants from Boehringer Ingelheim, Bristol Myers Squibb, and Pfizer. Dr Hijazi has received lecture and consulting fees from Boehringer Ingelheim, Bristol Myers Squibb, Pfizer, and Roche Diagnostics. Dr Oldgren has received institutional research grants from Amgen, AstraZeneca, Bayer, and Roche Diagnostics; and has received honoraria from Pfizer, paid to his institution. Dr Alexander has received institutional research grants from Artivion, Bayer, Bristol Myers Squibb, CSL Behring, Ferring, the U.S. Food and Drug Administration, Humacyte, and the U.S. National Institutes of Health and advisory board; and has received consulting fees or honoraria from AbbVie, Akros, Artivion, AtriCure, Bayer, Bristol Myers Squibb, Ferring, GlaxoSmithKline, Janssen, Novostia, Pfizer, Portola, Quantum Genomics, Theravance, Teikoku, and Veralox. Dr Berg has received grants from AstraZeneca and Pfizer; and has received consulting fees from AstraZeneca. Dr Goto has received financial support from the MEXT/Japan Society for the Promotion of Science KAKENHI 17K19669 and in part by 18H01726; has received research funding from Bristol Myers Squibb, Sanofi, Pfizer, and Ono; and has received modest personal fees from Bayer. Dr Lopes has received institutional research grants and consulting fees from Bristol Myers Squibb, GlaxoSmithKline, Medtronic, Pfizer, and Sanofi; and has received consulting fees from Amgen, Bayer, Boehringer Ingelheim, Daiichi-Sankyo, Merck, and Portola. Dr Siegbahn has received institutional research grants from AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb/Pfizer, GlaxoSmithKline, and Roche Diagnostics. Dr Giugliano has received grant support to his institution from Anthos and Daiichi-Sankyo; and has received personal fees from Artivion, Bayer, Daiichi-Sankyo, Medical Education Resources, Medscape, Menarini, Pfizer, SAJA Pharmaceuticals, Sanofi, and Servier. Dr Granger has received personal fees from Bayer and Boston Scientific; has received grants and personal fees from Boehringer Ingelheim, Bristol Myers Squibb, Janssen, and Pfizer; has received grants from Daiichi-Sankyo during the conduct of the study; has received personal fees from AbbVie, Espero, Medscape, Medtronic Inc, Merck, the National Institutes of Health, Novo Nordisk, Roche, Rho Pharmaceuticals, CeleCor, Correvio, Philips, Abiomed, and Anthos Therapeutics; has received grants from Akros, AstraZeneca, the U.S. Food and Drug Administration, GlaxoSmithKline, Medtronic Foundation, and Apple; and has received grants and personal fees from Novartis and The Medicines Company outside the submitted work. Dr Morrow has received consulting fees from Abbott Laboratories, ARCA Biopharma, InCarda, Inflammatix, Merck & Co, Novartis, and Roche Diagnostics. Drs Berg, Ruff, Giugliano, and Morrow are members of the TIMI Study Group, which has received institutional research grant support through Brigham and Women’s Hospital from Abbott, Amgen, Anthos Therapeutics, AstraZeneca, Bayer HealthCare Pharmaceuticals Inc, Daiichi-Sankyo, Eisai, Intarcia, MedImmune, Merck, Novartis, Pfizer, Quark Pharmaceuticals, Regeneron Pharmaceuticals Inc, Roche, Siemens Healthcare Diagnostics Inc, The Medicines Company, and Zora Biosciences. All other authors have reported that they have no relationships relevant to the content of this paper to disclose.
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