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

 Moonki Jung  ;  Kyeongmin Byeon  ;  Ki-Woon Kang  ;  Yae Min Park  ;  You Mi Hwang  ;  Sung Ho Lee  ;  Eun-Sun Jin  ;  Seung-Young Roh  ;  Jin Seok Kim  ;  Jinhee Ahn  ;  So-Ryoung Lee  ;  Eue-Keun Choi  ;  Min-Soo Ahn  ;  Eun Mi Lee  ;  Hwan-Cheol Park  ;  Ki Hong Lee  ;  Min Kim  ;  Joon Hyouk Choi  ;  Jum Suk Ko  ;  Jin Bae Kim  ;  Changsoo Kim  ;  Gregory Y H Lip  ;  Seung Yong Shin 
 YONSEI MEDICAL JOURNAL, Vol.63(10) : 892-901, 2022-10 
Journal Title
Issue Date
Anticoagulants / therapeutic use ; Atrial Fibrillation* / complications ; Atrial Fibrillation* / drug therapy ; Atrial Fibrillation* / epidemiology ; Biomarkers ; Cohort Studies ; Creatinine ; Female ; Fibrinolytic Agents ; Humans ; Middle Aged ; Natriuretic Peptide, Brain ; Republic of Korea / epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke* / etiology
ABCD score ; Atrial fibrillation ; risk stratification ; stroke
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.
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1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Chang Soo(김창수) ORCID logo https://orcid.org/0000-0002-5940-5649
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