Xing Lucas Yixi, Diederichsen Søren Zöga, Højberg Søren, Krieger Derk W, Graff Claus, Frikke-Schmidt Ruth, Platonov Pyotr G, Olesen Morten S, Brandes Axel, Køber Lars, Haugan Ketil Jørgen, Svendsen Jesper Hastrup
Department of Cardiology Copenhagen University Hospital-Rigshospitalet Copenhagen Denmark.
Department of Cardiology Zealand University Hospital-Roskilde Roskilde Denmark.
J Am Heart Assoc. 2024 Feb 20;13(4):e032744. doi: 10.1161/JAHA.123.032744. Epub 2024 Feb 14.
The ABC-stroke score is a risk scheme for prediction of stroke or systemic embolism (SE) in atrial fibrillation (AF). This study sought to examine whether the score could be useful in predicting stroke in AF-naïve individuals and risk stratifying for AF screening.
The LOOP (Atrial Fibrillation Detected by Continuous ECG Monitoring Using Implantable Loop Recorder to Prevent Stroke in High-Risk Individuals) study randomized 6004 AF-naïve individuals aged 70 to 90 years with stroke risk factors to either screening with an implantable loop recorder and anticoagulation upon detection of new-onset AF episodes ≥6 minutes, or usual care. A total of 5781 participants had available ABC-stroke score at baseline and were included in this secondary analysis: 4170 (72.1%) with an estimated stroke/SE risk ≤1%/year versus 1611 (27.9%) with an estimated stroke/SE risk >1%/year. Having an annual ABC-stroke risk >1% was associated with stroke/SE, stroke/SE/cardiovascular death, and all-cause death (hazard ratio, 1.82 [95% CI, 1.44-2.21], 2.17 [95% CI, 1.80-2.62], and 2.19 [95% CI, 1.87-2.56], respectively). For screening with implantable loop recorder versus usual care, no significant reduction in these study outcomes was obtained in any ABC-stroke risk groups (>0.0500 for all), with no signal toward interaction (>0.2500 for all). Similar findings were yielded when assessing the ABC-stroke score as a continuous variable.
In an elderly, AF-naïve population with additional stroke risk factors, a higher ABC-stroke score could identify individuals with increased stroke risk. However, this risk score may not be useful in pinpointing those more likely to benefit from AF screening and subsequent preventive treatment. These findings should be considered as hypothesis generating and warrant further study.
URL: https://www.clinicaltrials.gov; unique identifier: NCT02036450.
ABC 卒中评分是一种用于预测心房颤动（AF）患者发生卒中或全身性栓塞（SE）风险的方案。本研究旨在探讨该评分是否有助于预测初发 AF 个体的卒中情况以及对 AF 筛查进行风险分层。
LOOP（使用植入式环路记录器通过连续心电图监测检测心房颤动以预防高危个体卒中）研究将 6004 名年龄在 70 至 90 岁、有卒中风险因素的初发 AF 个体随机分为两组，一组使用植入式环路记录器进行筛查，在检测到新发 AF 发作≥6 分钟时进行抗凝治疗，另一组接受常规治疗。共有 5781 名参与者在基线时可获得 ABC 卒中评分，并纳入本次二次分析：4170 名（72.1%）估计卒中/SE 风险≤1%/年，1611 名（27.9%）估计卒中/SE 风险>1%/年。年度 ABC 卒中风险>1%与卒中/SE、卒中/SE/心血管死亡以及全因死亡相关（风险比分别为 1.82[95%CI，1.44 - 2.21]、2.17[95%CI，1.80 - 2.62]和 2.19[95%CI，1.87 - 2.56]）。对于使用植入式环路记录器筛查与常规治疗，在任何 ABC 卒中风险组中这些研究结局均未显著降低（所有 P>0.0500），且无交互作用信号（所有 P>0.2500）。将 ABC 卒中评分作为连续变量进行评估时也得出了类似结果。
在有额外卒中风险因素的老年初发 AF 人群中，较高的 ABC 卒中评分可识别出卒中风险增加的个体。然而，该风险评分可能无助于确定哪些人更可能从 AF 筛查及后续预防性治疗中获益。这些发现应被视为提出假设，有待进一步研究。
