Thrombosis and haemostasis · 2020
Predicting Adverse Events beyond Stroke and Bleeding with the ABC-Stroke and ABC-Bleeding Scores in Patients with Atrial Fibrillation: The Murcia AF Project.
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Camelo-Castillo Anny, Rivera-Caravaca José Miguel, Marín Francisco, Vicente Vicente, Lip Gregory Y H, Roldán Vanessa
Аннотация
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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 (p = 0.367 and p = 0.286, respectively); both scores were higher in patients with acute HF, cardiovascular events, or death (all p < 0.05). Predictive performances for the ABC-stroke and ABC-bleeding scores were similar, ranging from "poor" for MI (c-indexes ∼0.54), "moderate" for acute HF and cardiovascular events (c-indexes ∼0.60 and ∼0.64, respectively), and "good" for all-cause mortality (c-indexes > 0.70). Clinical usefulness whether assessed by ABC-stroke or ABC-bleeding was similar for various primary endpoints.
CONCLUSION: 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.
METHODS: 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.
RESULTS: 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 (p = 0.367 and p = 0.286, respectively); both scores were higher in patients with acute HF, cardiovascular events, or death (all p < 0.05). Predictive performances for the ABC-stroke and ABC-bleeding scores were similar, ranging from "poor" for MI (c-indexes ∼0.54), "moderate" for acute HF and cardiovascular events (c-indexes ∼0.60 and ∼0.64, respectively), and "good" for all-cause mortality (c-indexes > 0.70). Clinical usefulness whether assessed by ABC-stroke or ABC-bleeding was similar for various primary endpoints.
CONCLUSION: 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.
Предметные рубрики MeSH
Age FactorsAgedAged, 80 and overAnticoagulantsArea Under CurveAtrial FibrillationBiomarkersCardiovascular AgentsCause of DeathComorbidityDeath, Sudden, CardiacDecision Support TechniquesFemaleHeart FailureHemorrhageHumansMaleMortalityMyocardial InfarctionPlatelet Aggregation InhibitorsPrognosisROC CurveSeverity of Illness IndexStrokeVitamin K