ABC-AF Risk Scores Offer Superior Stroke Prediction in AF Patients: Study

A new study published in the Journal of the American College of Cardiology showed that the patients with atrial fibrillation (AF) on oral anticoagulation, which includes NT-proBNP and high-sensitivity troponin outperforms clinical ratings in predicting stroke.

The risk of ischemic stroke is a major factor in stroke prevention therapy recommendations for people with atrial fibrillation (AF). It is known that a patient receiving direct oral anticoagulant treatment today still has a chance of having a stroke, which might range from 0.3% to 0.9% annually.

The true vision for the future was that if patients treated with a direct oral anticoagulant still had a high risk of stroke, they might benefit from additional treatment such as left atrial appendage occlusion [LAAO] devices, or perhaps have a more liberal indication for ablation to eliminate A-fib or lessen the burden of A-fib as a stroke risk indicator.

This was because the risk of stroke still varies during oral anticoagulant treatment. Thus, this study was to assess the biomarker-based Age, Biomarkers, Clinical history (ABC)-AF-stroke risk score. Lars Wallentin and colleagues also created a modified ABC-AF-istroke risk score to predict total stroke and ischemic stroke in AF patients, respectively.

The ABC-AF-stroke score and the modified ABC-AF-istroke score were calculated using data clinical history of stroke, on age, and levels of N-terminal pro B-type natriuretic peptide and troponin in 26,452 AF patients who were assigned to direct oral anticoagulants (DOACs) or warfarin.

There were 756 incidents of stroke or systemic embolism (SEE) throughout the follow-up period, including 534 cases of ischemic stroke/SEE. In comparison to the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) score of 0.632 and the CHA2DS2-VASc score of 0.614, the ABC-AF-stroke score, C-index, demonstrated greater discrimination of total stroke/SEE. With a C-index for ABC-AF-istroke of 0.677 when compared to 0.642 for the ATRIA and 0.624 for the CHA2DS2-VASc score, the outcomes for ischemic stroke/SEE were comparable (P < 0.001 for both).

For both total and ischemic stroke, the ABC-AF-stroke scores demonstrated satisfactory calibration. In the pertinent subgroups, the results were consistent. Analysis of decision curves revealed a net advantage with regard to decision thresholds for stroke prevention. Overall, when it came to predicting total and ischemic stroke, the biomarker-based ABC-AF risk scores were well-calibrated, demonstrated superior discrimination over clinical risk scores, and offered significant decision assistance for stroke-prevention therapies in AF patients.

Reference:

Wallentin, L., Lindbäck, J., Hijazi, Z., Oldgren, J., Carnicelli, A. P., Alexander, J. H., Berg, D. D., Eikelboom, J. W., Goto, S., Lopes, R. D., Ruff, C. T., Siegbahn, A., Giugliano, R. P., Granger, C. B., & Morrow, D. A. (2025). Biomarker-based model for prediction of ischemic stroke in patients with Atrial Fibrillation. Journal of the American College of Cardiology, 85(11), 1173–1185. https://doi.org/10.1016/j.jacc.2024.11.052