Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (A.P.B., S.J.C., J.W.E.).
Uppsala Clinical Research Center (Z.H., J.L., J.O., A.S., L.W.), Uppsala University, Sweden.
Circulation. 2021 May 11;143(19):1863-1873. doi: 10.1161/CIRCULATIONAHA.120.053100. Epub 2021 Apr 14.
The novel ABC (Age, Biomarkers, Clinical History) scores outperform traditional risk scores for stroke, major bleeding, and death in patients with atrial fibrillation (AF) receiving oral anticoagulation. To refine their utility, the ABC-AF scores needed to be validated in patients not receiving oral anticoagulation.
We measured plasma levels of the ABC biomarkers (N-terminal pro-B-type natriuretic peptide, cardiac troponin-T, and growth-differentiation factor 15) to apply the previously developed ABC-AF scores in patients with AF receiving aspirin (n=3195) or aspirin and clopidogrel (n=1110) in 2 large clinical trials. Calibration was assessed by comparing estimated with observed 1-year risks. Cox regression models were used for recalibration. Discrimination was evaluated separately for the aspirin-only and the overall cohort (n=4305).
The ABC-AF-stroke score yielded a c-index of 0.70 (95% CI, 0.67-0.73) in both cohorts. The ABC-AF-bleeding score had a c-index of 0.76 (95% CI, 0.71-0.81) in the aspirin-only cohort and 0.73 (95% CI, 0.69-0.77) overall. Both scores were superior to risk scores recommended by current guidelines. The ABC-AF-death score yielded a c-index of 0.78 (95% CI, 0.76-0.80) overall. Calibrated in patients receiving oral anticoagulation, the ABC-AF-stroke score underestimated and the ABC-AF-bleeding score overestimated the risk of events in both cohorts. These scores were recalibrated for prediction of absolute event rates in the absence of oral anticoagulation.
The biomarker-based ABC-AF scores showed better discrimination than traditional risk scores and were recalibrated for precise risk estimation in patients not receiving oral anticoagulation. They can now provide improved decision support on treatment of an individual patient with AF.
新型 ABC（年龄、生物标志物、临床病史）评分在接受口服抗凝治疗的房颤患者中优于传统的中风、大出血和死亡风险评分。为了进一步提高其效用，需要在未接受口服抗凝治疗的患者中验证 ABC-AF 评分。
我们测量了房颤患者中应用先前开发的 ABC-AF 评分的血浆 ABC 生物标志物（氨基末端 B 型利钠肽前体、心脏肌钙蛋白 T 和生长分化因子 15）水平，这些患者正在接受阿司匹林（n=3195）或阿司匹林和氯吡格雷（n=1110）治疗，这是两项大型临床试验。通过比较估计的 1 年风险和观察到的风险来评估校准。使用 Cox 回归模型进行重新校准。分别评估阿司匹林组和总体队列（n=4305）的判别能力。
在两个队列中，ABC-AF-中风评分的 c 指数为 0.70（95%可信区间，0.67-0.73）。在仅接受阿司匹林的队列中，ABC-AF-出血评分的 c 指数为 0.76（95%可信区间，0.71-0.81），总体为 0.73（95%可信区间，0.69-0.77）。这两个评分均优于现行指南推荐的风险评分。ABC-AF-死亡评分的总体 c 指数为 0.78（95%可信区间，0.76-0.80）。在接受口服抗凝治疗的患者中进行校准后，ABC-AF-中风评分低估，ABC-AF-出血评分高估了两个队列的事件风险。为了在没有口服抗凝治疗的情况下预测绝对事件发生率，对这些评分进行了重新校准。
基于生物标志物的 ABC-AF 评分比传统风险评分具有更好的判别能力，并针对未接受口服抗凝治疗的患者进行了重新校准，以进行更精确的风险估计。它们现在可以为房颤患者的个体化治疗提供更好的决策支持。
