The ABC (age, biomarkers, clinical history) stroke risk score: a biomarker-based risk score for predicting stroke in atrial fibrillation
Aims Atrial fibrillation (AF) is associated with an increased risk of stroke, which is currently estimated by clinical characteristics. The cardiac biomarkers N-terminal fragment B-type natriuretic peptide (NT-proBNP) and cardiac troponin high-sensitivity (cTn-hs) are independently associated with risk of stroke in AF. Our objective was to develop and validate a new biomarker-based risk score to improve prognostication of stroke in patients with AF. Methods and results A new risk score was developed and internally validated in 14 701 patients with AF and biomarkers levels determined at baseline, median follow-up of 1.9 years. Biomarkers and clinical variables significantly contributing to predicting stroke or systemic embolism were assessed by Cox-regression and each variable obtained a weight proportional to the model coefficients. External validation was performed in 1400 patients with AF, median follow-up of 3.4 years. The most important predictors were prior stroke/transient ischaemic attack, NT-proBNP, cTn-hs, and age, which were included in the ABC (Age, Biomarkers, Clinical history) stroke risk score. The ABC-stroke score was well calibrated and yielded higher c-indices than the widely used CHA2DS2-VASc score in both the derivation cohort (0.68 vs. 0.62, P
Conclusions: Statin therapy for AF-related stroke may reduce all-cause mortality and improve functional outcomes. Randomized controlled studies are warranted to confirm the effects of statins on the outcomes of AF-related stroke.
CONCLUSIONS: In highly selected patients at very HBR, discontinuation of any antithrombotic therapy after LAAC appears safe and feasible. PMID: 32999093 [PubMed - in process]
Atrial fibrillation (AF) and heart failure (HF) carry a poor prognosis in acute ischaemic stroke (AIS). The impact of revascularisation therapies on outcomes in these patients is not fully understood.
ConclusionsIn the treatment of AF, CA appeared to be superior to AADs, decreasing the risk of all-cause death and cardiovascular hospitalization and improving the long-term QoL of patients with AF. CA was better tolerated and more effective than pharmacological therapy and allowed for improved QoL.
Atrial fibrillation (AF) is the most common arrhythmia, with a substantial rise in global incidence and prevalence. Ischemic stroke is a frequent complication of AF, since AF perfectly fulfills Virchow's triad of blood stasis, vascular damage and hypercoagulation, making oral anticoagulation (OAC) obligatory for stroke prevention. Direct oral anticoagulants (DOAC), such as dabigatran, which inhibits thrombin, and apixaban, edoxaban and rivaroxaban, which block the activated coagulation factor X (FXa), have some advantages and are largely replacing coumarin-based OAC.
We examined the association between LDL-C levels and incident stroke in patients with atrial fibrillation treated with direct oral anticoagulants (DOACs).
AbstractPurposeOptimal stroke prevention strategies for patients with atrial fibrillation (AF) who experience a major bleed are poorly defined. We sought to estimate the effectiveness and safety of oral anticoagulation (OAC) represcription after an OAC contraindication.MethodsTREAT-AF is a retrospective cohort study of patients with newly diagnosed AF (2004 –2012), treated in the Veterans Health Administration. From this cohort, we identified patients with a contraindication to OAC after AF diagnoses, defined as incident intracranial bleeding, non-intracranial bleeding requiring hospitalization, or unrepaired cerebra...
ConclusionIn NVAF patients of all ages initiating either apixaban or warfarin for stroke prevention in the Sentinel System, apixaban was associated with a decreased risk of GI bleeding, ICH, and ischemic stroke compared with warfarin. Among patients less than 65 years of age, apixaban use was associated with a decreased risk of GI bleeding and ischemic stroke.
ConclusionsPostoperative implantation of a permanent RV pacemaker does not alter the long ‐term risks of HF and mortality following mitral valve surgery.
ConclusionsA high NLR on admission could be a useful marker for predicting poor short ‐term outcome in patients with mild AIS following IVT.