AUTHOR=Niederdöckl Jan , Oppenauer Julia , Schnaubelt Sebastian , Cacioppo Filippo , Buchtele Nina , Warenits Alexandra-Maria , Laggner Roberta , Schütz Nikola , Bögl Magdalena S. , Ruzicka Gerhard , Gupta Sophie , Lutnik Martin , Sheikh Rezaei Safoura , Wolzt Michael , Herkner Harald , Domanovits Hans , Laggner Anton N. , Schwameis Michael , Hijazi Ziad 

TITLE=The ABC-Stroke Score Refines Stroke Risk Stratification in Patients With Atrial Fibrillation at the Emergency Department

JOURNAL=Frontiers in Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.830580

DOI=10.3389/fmed.2022.830580

ISSN=2296-858X

ABSTRACT=<sec><title>Aims</title><p>To evaluate the performance of the ABC (Age, Biomarkers, Clinical history) and CHA<sub>2</sub>DS<sub>2</sub>-VASc stroke scores under real-world conditions in an emergency setting.</p></sec><sec><title>Methods and Results</title><p>The performance of the biomarker-based ABC-stroke score and the clinical variable-based CHA<sub>2</sub>DS<sub>2</sub>-VASc score for stroke risk assessment were prospectively evaluated in a consecutive series of 2,108 patients with acute symptomatic atrial fibrillation at a tertiary care emergency department. Performance was assessed according to methods for the development and validation of clinical prediction models by Steyerberg et al. and the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis. During a cumulative observation period of 3,686 person-years, the stroke incidence rate was 1.66 per 100 person-years. Overall, the ABC-stroke and CHA<sub>2</sub>DS<sub>2</sub>-VASc scores revealed respective c-indices of 0.64 and 0.55 for stroke prediction. Risk-class hazard ratios comparing moderate to low and high to low were 3.51 and 2.56 for the ABC-stroke score and 1.10 and 1.62 for the CHA<sub>2</sub>DS<sub>2</sub>-VASc score. The ABC-stroke score also provided improved risk stratification in patients with moderate stroke risk according to the CHA<sub>2</sub>DS<sub>2</sub>-VASc score, who lack clear recommendations regarding anticoagulation therapy (HR: 4.35, <italic>P</italic> = 0.001). Decision curve analysis indicated a superior net clinical benefit of using the ABC-stroke score.</p></sec><sec><title>Conclusion</title><p>In a large, real-world cohort of patients with acute atrial fibrillation in the emergency department, the ABC-stroke score was superior to the guideline-recommended CHA<sub>2</sub>DS<sub>2</sub>-VASc score at predicting stroke risk and refined risk stratification of patients labeled moderate risk by the CHA<sub>2</sub>DS<sub>2</sub>-VASc score, potentially easing treatment decision-making.</p></sec>