Heart rhythm · 2026
External validation and comparison of published stroke risk scores in a Chinese cohort of patients with atrial fibrillation.
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Gong Aobo, Ren Bangjiaxin, Cao Ying, Li Zexi, Li Fanghui, Li Wenjie, Hu Xianjin, Zhou Yifan, Zeng Rui
Аннотация
BACKGROUND: Accurate prediction of ischemic stroke or systemic embolism is central to atrial fibrillation (AF) management, yet the applicability of available risk scores to Chinese populations remains uncertain.
OBJECTIVE: The aim of this study was to externally validate and compare published stroke risk scores in Chinese patients with nonvalvular AF.
METHODS: We systematically retrieved and externally validated 17 published models in a retrospective cohort of 1283 adults hospitalized with nonvalvular AF at a Chinese tertiary-care center. Discrimination was evaluated using the 4-year Uno C-index and time-dependent areas under the curve. Models that provided absolute risks also underwent calibration, Brier score, and reclassification analyses. Sensitivity analyses accounted for death as a competing event and separately evaluated patients who were not receiving oral anticoagulant at baseline.
RESULTS: During 4 years of follow-up, 103 primary outcomes occurred, corresponding to 2.85 events per 100 person-years. Across models, 4-year Uno C-indices ranged from 0.572 to 0.767, compared with 0.690 for CHA2DS2-VASc. GARFIELD-AF 2017, GARFIELD-AF 2021, and ATRIA had higher Uno C-indices than CHA2DS2-VASc. However, no model had a significantly higher time-dependent areas under the curve at any time point. For 1-year calibration, CHA2DS2-VASc had predicted and observed risks of 3.39% and 3.54%, respectively, with an observed-to-expected ratio of 1.04, whereas several other models underestimated the risk. Brier scores and reclassification measures showed no consistent advantage. Competing-risk analyses lowered the cumulative incidence without changing comparative patterns. Among patients not receiving oral anticoagulant at baseline, no model outperformed CHA2DS2-VASc.
CONCLUSION: Candidate models did not consistently outperform CHA2DS2-VASc in this external validation; CHA2DS2-VASc remains practical, whereas other models may require population-specific validation and recalibration.
OBJECTIVE: The aim of this study was to externally validate and compare published stroke risk scores in Chinese patients with nonvalvular AF.
METHODS: We systematically retrieved and externally validated 17 published models in a retrospective cohort of 1283 adults hospitalized with nonvalvular AF at a Chinese tertiary-care center. Discrimination was evaluated using the 4-year Uno C-index and time-dependent areas under the curve. Models that provided absolute risks also underwent calibration, Brier score, and reclassification analyses. Sensitivity analyses accounted for death as a competing event and separately evaluated patients who were not receiving oral anticoagulant at baseline.
RESULTS: During 4 years of follow-up, 103 primary outcomes occurred, corresponding to 2.85 events per 100 person-years. Across models, 4-year Uno C-indices ranged from 0.572 to 0.767, compared with 0.690 for CHA2DS2-VASc. GARFIELD-AF 2017, GARFIELD-AF 2021, and ATRIA had higher Uno C-indices than CHA2DS2-VASc. However, no model had a significantly higher time-dependent areas under the curve at any time point. For 1-year calibration, CHA2DS2-VASc had predicted and observed risks of 3.39% and 3.54%, respectively, with an observed-to-expected ratio of 1.04, whereas several other models underestimated the risk. Brier scores and reclassification measures showed no consistent advantage. Competing-risk analyses lowered the cumulative incidence without changing comparative patterns. Among patients not receiving oral anticoagulant at baseline, no model outperformed CHA2DS2-VASc.
CONCLUSION: Candidate models did not consistently outperform CHA2DS2-VASc in this external validation; CHA2DS2-VASc remains practical, whereas other models may require population-specific validation and recalibration.