A New Risk Scheme to Predict Ischemic Stroke and Other Thromboembolism in Atrial Fibrillation: The ATRIA Study Stroke Risk Score

Abstract

BackgroundMore accurate and reliable stroke risk prediction tools are needed to optimize anticoagulation decision making in patients with atrial fibrillation (AF). We developed a new AF stroke prediction model using the original Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) AF cohort and externally validated the score in a separate, contemporary, community‐based inception AF cohort, ATRIA–Cardiovascular Research Network (CVRN) cohort.Methods and ResultsThe derivation ATRIA cohort consisted of 10 927 patients with nonvalvular AF contributing 32 609 person‐years off warfarin and 685 thromboembolic events (TEs). The external validation ATRIA‐CVRN cohort included 25 306 AF patients contributing 26 263 person‐years off warfarin and 496 TEs. Cox models identified 8 variables, age, prior stroke, female sex, diabetes mellitus, heart failure, hypertension, proteinuria, and eGFR<45 mL/min per 1.73 m2 or end‐stage renal disease, plus an age×prior stroke interaction term for the final model. Point scores were assigned proportional to model coefficients. The c‐index in the ATRIA cohort was 0.73 (95% CI, 0.71 to 0.75), increasing to 0.76 (95% CI, 0.74 to 0.79) when only severe events were considered. In the ATRIA‐CVRN, c‐indexes were 0.70 (95% CI, 0.67 to 0.72) and 0.75 (95% CI, 0.72 to 0.78) for all events and severe events, respectively. The C‐index was greater and net reclassification improvement positive comparing the ATRIA score with the CHADS2 or CHA2DS2‐VASc scores.ConclusionsThe ATRIA stroke risk score performed better than existing risk scores, was validated successfully, and showed improvement in predicting severe events, which is of greatest concern. The ATRIA score should improve the antithrombotic decision for patients with AF and should provide a secure foundation for the addition of biomarkers in future prognostic models.

Meta-Analysis of the Influence of Chronic Kidney Disease on the Risk of Thromboembolism Among Patients With Nonvalvular Atrial Fibrillation

“…Its external validation has shown promising results with higher C statistics (0.70; 95% CI 0.67 to 0.72) than the CHADS 2 (0.66; 95% CI 0.64 to 0.69) or CHA 2 DS 2 -VASc (0.68; 95% CI 0.66 to 0.70) score for the discrimination of all thromboembolic events. 24 The discriminative performance of this score was even better if only severe thromboembolic events were considered (C statistic ¼ 0.75; 95% CI 0.73 to 0.78), remaining better than CHADS 2 (C statistic ¼ 0.71; 95% CI 0.68 to 0.73) and CHA 2 DS 2 -VASc (C statistic ¼ 0.72; 95% CI 0.69 to 0.74) scores. When assessing the net reclassification improvement obtained by the use of the new score, it was verified that 24% to 25% of patients were correctly reclassified into an adequate risk category, compared with CHADS 2 and CHA 2 DS 2 -VASc scores, respectively (the percentage increased to 33% if only severe events were measured).…”

Optimum Risk Assessment for Stroke in Atrial Fibrillation: Should We Hold the Status Quo or Consider Magnitude Synergism and Left Atrial Appendage Anatomy?

“…reported on an additional approach, the ATRIA score, 46 as an alternative with a greater C-index than they found with CHADS 2 or CHA 2 DS 2 -VASc. The ATRIA score (Table 1) is based on age, female gender, diabetes mellitus, heart failure, hypertension, proteinuria and estimated glomerular filtration rate stratified by the presence or absence of prior stroke.…”

Using an index of transmural repolarization dispersion for the diagnosis of hemodynamically signifi cant arrhythmias in children with left ventricular false tendons

“…Таким образом, выявленные независимые факторы раз-вития СА блокад у детей с АРХЛЖ позволяют оптимально проводить стратификацию риска на-рушений проводимости и отбор потенциальных кандидатов для углубленного кардиологического обследования. В настоящее время имеются убедительные данные о прогностической значимости НЖЭС в оценке риска фибрилляции предсердий, па-роксизмальных наджелудочковых и желудочко-вых тахикардий [11]. Кроме того, известно, что течение ишемической болезни сердца у паци-ентов на фоне МАС чаще осложняется фибрил-ляцией предсердий [1].…”

“…Кроме того, известно, что течение ишемической болезни сердца у паци-ентов на фоне МАС чаще осложняется фибрил-ляцией предсердий [1]. Вызывает насторожен-ность и тот факт, что согласно исследованию ATRIA (Anticoagulation and Risk factors in Atrial fi brillation) риск развития ФП увеличивается [11]. По данным ряда исследователей, распространен-ность экстрасистолии у детей с АРХЛЖ состав-ляет 78-90%.…”