Identification of Markers Associated With Development of Stroke in “Clinically Low-Risk” Atrial Fibrillation Patients

Seung Yong Shin, Sang Jin Han, Jin Seok Kim, Sung Il Im, Jaemin Shim, Jinhee Ahn, Eun Mi Lee, Yae Min Park, Jun Hyung Kim, Gregory Y.H. Lip, Hong Euy Lim

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    25 Citations (Scopus)


    Background: Stroke and thromboembolic events may still occur in “clinically low-risk” atrial fibrillation (AF) patients as categorized by CHA2DS2-VASc score. Our aim was to assess the proportion of “clinically low-risk” patients using a nongender CHA2DS2-VASc (ie, CHA2DS2-VA) score of 0 to 1 among patients who experienced AF-associated stroke and to identify markers associated with stroke in “clinically low-risk” patients. Methods and Results: We retrospectively recruited nonvalvular AF patients who experienced embolic stroke between 2013 and 2016 from 9 institutes in Korea. AF patients with CHA2DS2-VA score of 0 to 1 at the time of stroke were analyzed and compared with “clinically low-risk” AF patients without stroke. A total of 3033 subjects with AF-associated stroke were recruited. Of these, 583 patients (19.2%) had CHA2DS2-VA score of 0 to 1. On multivariate analysis, age (≥60 years), N-terminal pro B-type natriuretic peptide (≥300 pg/mL), creatinine clearance (<50 mL/min), and left atrial dimension (≥45 mm) were independently associated with stroke. With the combined application of these 4 factors (collectively, ABCD score) to the “clinically low-risk” patients, the c-index was 0.858 (95% CI 0.838–0.877; P<0.001). Conclusions: The present study suggests a new insight into how additional use of markers can further refine stroke risk differentiation among AF patients initially classified as “clinically low-risk.”. Clinical Trial Registration: URL: Unique identifier: NCT03147911.

    Original languageEnglish
    Article numbere012697
    JournalJournal of the American Heart Association
    Issue number21
    Publication statusPublished - 2019 Nov 5

    Bibliographical note

    Funding Information:
    This study was sponsored by a grant from Samjin Pharmaceutical Co. Ltd.

    Publisher Copyright:
    © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.


    • ABCD score
    • atrial fibrillation
    • risk score
    • risk stratification
    • stroke, ischemic

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine


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