O U Fan, Chong Tou Kun, Wei Yulin, Lo Cheok Ian, Wu Wei
Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Department of Cardiology, Kiang Wu Hospital, Macau Special Administrative Region, Macao, China.
J Healthc Eng. 2022 Mar 8;2022:2863815. doi: 10.1155/2022/2863815. eCollection 2022.
Growth differentiation factor-15 (GDF-15) is a strong predictor of bleeding in atrial fibrillation (AF) patients. The novel ABC (age, biomarkers, and clinical history), AF, and bleeding risk score outperforms HAS-BLED bleeding risk score for major bleeding (MB) in patients with AF receiving oral anti-coagulation in the clinical trial cohort. However, it has not been entirely externally validated. We aimed to refine and understand the application of the ABC-AF bleeding risk score in elderly (aged ≥65 years old) patients with nonvalvular atrial fibrillation (NVAF) for predicting the different types of bleeding events and anti-thrombotic treatments.
We identified elderly patients with NVAF between March 2018 and December 2019 who were hospitalized for the first time after a diagnosis of NVAF. We measured the plasma concentration of the ABC biomarkers (growth differentiation factor 15 (GDF-15) and cardiac troponin-T (cTnT)) from enrolled patients. We collected their general information and follow up for one year until December 2020. During the follow-up period, information on the occurrence of bleeding events (major bleeding, clinically relevant nonmajor gastrointestinal bleeding (CRNM GIB), and minor bleeding events) was collected.
We enrolled 342 elderly NAVF patients; the ABC-AF bleeding and HAS-BLED scores were quantified. With an average of 1.5 years of follow-up, 6 patients had an intracranial hemorrhage; 57 patients had CRNM GIB; and 68 patients had minor bleeding events (36 fecal occult blood positive and 32 other minor bleeding events). The ABC-AF bleeding score yielded a C-index of 0.72 (95% CI 0.60-0.84) for predicting MB in elderly patients with NAVF, C-index of 0.69 (95% CI 0.57-0.82) by HAS-BLED score. Comparison of the incidence of bleeding events during follow-up and the predicted 1-year incidence of bleeding events by each bleeding risk score, ABC-AF bleeding, and HAS-BLED scores have similar value in predicting the risk for elderly patients with NAVF in different types of bleeding events, whether on oral anti-coagulation treatment (OAC) or non-OAC ( > 0.05).
In elderly patients with NVAF, the biomarker-based ABC-AF bleeding score showed similar performance compared with the HAS-BLED bleeding risk score.
生长分化因子-15（GDF-15）是心房颤动（AF）患者出血的有力预测指标。在临床试验队列中，新型ABC（年龄、生物标志物和临床病史）、AF及出血风险评分在接受口服抗凝治疗的AF患者主要出血（MB）方面优于HAS-BLED出血风险评分。然而，其尚未得到完全外部验证。我们旨在完善并了解ABC-AF出血风险评分在老年（≥65岁）非瓣膜性心房颤动（NVAF）患者中对不同类型出血事件及抗栓治疗的预测应用。
我们纳入了2018年3月至2019年12月期间首次因NVAF诊断住院的老年NVAF患者。我们检测了入组患者血浆中ABC生物标志物（生长分化因子15（GDF-15）和心肌肌钙蛋白T（cTnT））的浓度。我们收集了他们的一般信息并随访1年直至2020年12月。在随访期间，收集出血事件（主要出血、临床相关非主要胃肠道出血（CRNM GIB）和轻微出血事件）的发生信息。
我们纳入了342例老年NAVF患者；对ABC-AF出血及HAS-BLED评分进行了量化。平均随访1.5年，6例患者发生颅内出血；57例患者发生CRNM GIB；68例患者发生轻微出血事件（36例粪便潜血阳性和32例其他轻微出血事件）。ABC-AF出血评分预测老年NAVF患者MB的C指数为0.72（95%CI 0.60-0.84），HAS-BLED评分的C指数为0.69（95%CI 0.57-0.82）。比较随访期间出血事件的发生率以及各出血风险评分预测的1年出血事件发生率，ABC-AF出血评分和HAS-BLED评分在预测老年NAVF患者不同类型出血事件的风险方面具有相似价值，无论是否接受口服抗凝治疗（OAC）（P>0.05）。
在老年NVAF患者中，基于生物标志物的ABC-AF出血评分与HAS-BLED出血风险评分表现相似。
