ABC-AF-Stroke score predicts thromboembolism in non-anticoagulated patients following successful atrial fibrillation ablation : a report from the Chinese Atrial Fibrillation Registry

• Background: The age, biomarkers, and clinical history (ABC)-atrial fibrillation (AF)-Stroke score have been proposed to refinestroke risk stratification, beyond what clinical risk scores such as the CHA2DS2-VASc score can offer. This study aimed toidentify risk factors associated with thromboembolism and evaluate the performance of the ABC-AF-Stroke score in predictingthromboembolism in non-anticoagulated AF patients following successful ablations.Methods: A total of 2692 patients who underwent successful ablations with discontinued anticoagulation after a 3-monthblanking period in the Chinese Atrial Fibrillation Registry (CAFR) between 2013 and 2019 were included. Cox regressionanalysis was conducted to present the association of risk factors with thromboembolism risk. The ABC-AF-Stroke score wasevaluated in terms of discrimination, including concordance index (C-index), net reclassification improvement (NRI) andintegrated discrimination improvement (IDI), clinical utilization by decision curve analysis (DCA), and calibration bycomparing the predicted risk with the observed annualized event rate.Results: After a median follow-up of 3.5 years, 64 patients experienced thromboembolism events. Age, prior history of stroke/transient ischemic attack (TIA), high-sensitivity cardiac troponin T (cTnT-hs), and N-terminal pro-B-type natriuretic peptide(NT-proBNP) were independently associated with thromboembolism risk. The ABC-AF-Stroke score performed statisticallysignificantly better than the CHA2DS2-VASc score in terms of C-index (0.67, 95% confidence interval [CI]: 0.59–0.74 vs. 0.60,95% CI: 0.52–0.67, P = 0.030) and reclassification capacity. The DCA implied that the ABC-AF-Stroke score could identifymore thromboembolism events without increasing the false positive rate compared to the CHA2DS2-VASc score. The calibrationcurve showed that the ABC-AF-Stroke score was well calibrated in this population.Conclusions: In this real-world study enrolling non-anticoagulated AF patients following successful ablations, age, prior historyof stroke/TIA, level of NT-proBNP, and cTnT-hs were independently associated with an increased risk of thromboembolism.The ABC-AF-Stroke score was well-calibrated and statistically significantly outperformed the CHA2DS2-VASc score inpredicting thromboembolism risk.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

Atrial fibrillation

ABC-AF-Stroke score

CHAS(2)DS(2)-VASc

Thromboembolism

Catheter ablation

Publikations- och innehållstyp

ref (ämneskategori)

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