The ABC (age, biomarkers, clinical history) stroke risk score: a biomarker-based risk score for predicting stroke in atrial fibrillation
Open accessAbstract
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 < 0.001) and the external validation cohort (0.66 vs. 0.58, P < 0.001). Moreover, the ABC-stroke score consistently provided higher c-indices in several important subgroups. CONCLUSION: A novel biomarker-based risk score for predicting stroke in AF was successfully developed and internally validated in a large cohort of patients with AF and further externally validated in an independent AF cohort. The ABC-stroke score performed better than the presently used clinically based risk score and may provide improved decision support in AF. CLINICALTRIALS GOV IDENTIFIER: NCT00412984, NCT00799903.
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Measurement of cardiac troponin (high-sensitivity troponin T or I) and N-terminal pro-B-type natriuretic peptide may provide additional prognostic information in selected AF patients.
“Measurement of cardiac troponin (high-sensitivity troponin T or I) and N-terminal pro-B-type natriuretic peptide may provide additional prognostic information in selected AF patients.[380][381][382]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [382]
The most important risk factors for stroke in patients with AF are advanced age and previous cardioembolic stroke or TIA.
“The most important risk factors for stroke in patients with AF are advanced age and previous cardioembolic stroke or TIA, 382 emphasizing the need for OAC in these patients.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [382]
Age is one of the strongest predictors/risk factors for ischaemic stroke in AF.
“age is one of the strongest predictors/risk factors for ischaemic stroke in AF (Table 11).382”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [382]
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- Authors
- Hijazi, Z., Lindbäck, J., Alexander, J. H., Hanna, M., Held, C., Hylek, E. M., Lopes, R. D., Oldgren, J., Siegbahn, A., Stewart, R. A. H., White, H. D., Granger, C. B., & Wallentin, L.
- Affiliations
- Uppsala University (SE)
- Duke Clinical Research Institute (US)
- Bristol-Myers Squibb (United States) (US)
- Boston University (US)
- University of Auckland (NZ)
- Corresponding author
- Hijazi, Ziad
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-02-25
- Volume
- 37
- Issue
- 20
- Pages
- 1582-1590
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC4875560
- OpenAlex
- W2295490840
- Cited by
- 437
- References
- 34
- Citations by year
- 2026: 23 · 2025: 38 · 2024: 35 · 2023: 36 · 2022: 30 · 2021: 51 · 2020: 49 · 2019: 62 · 2018: 41 · 2017: 43 · 2016: 27
- FWCI
- 47.61
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- European Heart Journal (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- The Swedish Foundation for Strategic Research
- National Institute of Health
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- atrial fibrillation, stroke risk prediction, NT-proBNP, high-sensitivity troponin, systemic embolism, CHA2DS2-VASc score, risk stratification, transient ischemic attack
- MeSH terms
- Atrial Fibrillation, Humans, Medical History Taking, Risk Factors, Biomarkers, Risk Assessment, Natriuretic Peptide, Brain, Stroke
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