Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain.
Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, IMIB-Arrixaca, Murcia, Spain.
Thromb Haemost. 2020 Aug;120(8):1200-1207. doi: 10.1055/s-0040-1712914. Epub 2020 Jun 7.
The ABC (age, biomarkers, and clinical history)-stroke and ABC-bleeding are biomarker-based scores proposed to predict stroke and bleeding, but non-specificity of biomarkers is common, predicting different clinical events at the same time. We assessed the predictive performance of the ABC-stroke and ABC-bleeding scores, for outcomes beyond ischemic stroke and major bleeding, in a cohort of atrial fibrillation (AF) patients.
We included AF patients stable on vitamin K antagonists for 6 months. The ABC-stroke and ABC-bleeding were calculated and the predictive values for myocardial infarction (MI), acute heart failure (HF), a composite of cardiovascular events, and all-cause deaths were compared.
We included 1,044 patients (49.2% male; median age 76 [71-81] years). During 6.5 (4.3-7.9) years, there were 58 (5.6%) MIs, 98 (9.4%) acute HFs, 167 (16%) cardiovascular events, and 418 (40%) all-cause deaths. There were no differences in mean ABC-stroke and ABC-bleeding scores in patients with/without MI ( = 0.367 and = 0.286, respectively); both scores were higher in patients with acute HF, cardiovascular events, or death (all < 0.05). Predictive performances for the ABC-stroke and ABC-bleeding scores were similar, ranging from "poor" for MI (-indexes ∼0.54), "moderate" for acute HF and cardiovascular events (-indexes ∼0.60 and ∼0.64, respectively), and "good" for all-cause mortality (-indexes > 0.70). Clinical usefulness whether assessed by ABC-stroke or ABC-bleeding was similar for various primary endpoints.
In AF patients, the ABC-stroke and ABC-bleeding scores demonstrated similar predictive ability for outcomes beyond stroke and bleeding, including MI, acute HF, a composite of cardiovascular events, and all-cause deaths. This is consistent with nonspecificity of biomarkers that predict "sick" patients or poor prognosis overall.
ABC（年龄、生物标志物和临床病史）-中风和 ABC-出血是基于生物标志物的评分，用于预测中风和出血，但生物标志物的非特异性很常见，同时预测不同的临床事件。我们评估了 ABC-中风和 ABC-出血评分在心房颤动 (AF) 患者队列中预测除缺血性中风和大出血以外的结局的预测性能。
我们纳入了稳定服用维生素 K 拮抗剂 6 个月的 AF 患者。计算了 ABC-中风和 ABC-出血评分，并比较了其对心肌梗死 (MI)、急性心力衰竭 (HF)、心血管事件综合和全因死亡的预测价值。
我们纳入了 1044 名患者（49.2%为男性；中位年龄 76[71-81]岁）。在 6.5（4.3-7.9）年期间，有 58 例 MI（5.6%）、98 例急性 HF（9.4%）、167 例心血管事件（16%）和 418 例全因死亡（40%）。MI 患者的 ABC-中风和 ABC-出血评分均值无差异（ = 0.367 和 = 0.286）；急性 HF、心血管事件或死亡患者的评分均较高（均 < 0.05）。ABC-中风和 ABC-出血评分的预测性能相似，对 MI 的预测范围为“较差”（指数值约为 0.54），对急性 HF 和心血管事件的预测范围为“中等”（指数值分别为 0.60 和 0.64），对全因死亡率的预测范围为“良好”（指数值 > 0.70）。无论是使用 ABC-中风还是 ABC-出血评分评估，临床用途在各种主要终点上均相似。
在 AF 患者中，ABC-中风和 ABC-出血评分对中风和出血以外的结局（包括 MI、急性 HF、心血管事件综合和全因死亡）具有相似的预测能力。这与生物标志物的非特异性一致，生物标志物可预测“患病”患者或总体预后不良。
