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Refining stroke and bleeding prediction in atrial fibrillation by adding consecutive biomarkers to clinical risk scores

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dc.contributor.authorRivera Caravaca, José Miguel
dc.contributor.authorMarín Ortuño, Francisco
dc.contributor.authorVílchez Aguilera, Juan Antonio
dc.contributor.authorGálvez, Josefa
dc.contributor.authorEsteve-Pastor, María Asunción
dc.contributor.authorVicente García, Vicente
dc.contributor.authorLip, Gregory YH
dc.contributor.authorRoldán Schilling, Vanessa
dc.contributor.departmentEnfermería
dc.date.accessioned2024-02-07T09:44:22Z
dc.date.available2024-02-07T09:44:22Z
dc.date.issued2019
dc.descriptionAcceso restringido
dc.description.abstractBackground and Purpose: Current European guidelines for the management of atrial fibrillation suggest using biomarkers to refine the risk stratification process. However, it is unclear whether ≥2 biomarkers incrementally improve risk prediction beyond 1 biomarker alone. We investigated whether the predictive performance of CHA2DS2-VASc and HASBLED scores could be enhanced by incrementally adding consecutive different biomarkers in real-world atrial fibrillation patients taking vitamin K antagonists therapy. Methods: We included 940 atrial fibrillation patients stable on vitamin K antagonists (international normalized ratio, 2.0–3.0) for at least the previous 6 months. At inclusion, VWF (von Willebrand factor), high-sensitivity troponin T, NTproBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity IL (interleukin)-6, fibrin monomers, and BTP (β-trace protein) concentrations were quantified. During follow-up, all adverse events were recorded, and biomarkers were added to CHA2DS2-VASc and HAS-BLED scores depending on the C index. Results: During 6.5 (4.3–7.9) years, there were 98 ischemic strokes (1.60% per year) and 172 major bleeds (1.60% per year). After the addition of biomarkers, the predictive performance of CHA2DS2-VASc was not significantly increased, although the model with 3 biomarkers (ie, NT-proBNP+BTP+VWF) showed a low gain in sensitivity (integrated discrimination improvement, 2.70%; P<0.001). The predictive performance of HAS-BLED was enhanced in all biomarker-based models, with the best prediction shown by the model with 3 biomarkers (ie, VWF+NT-proBNP+high-sensitivity IL-6; C index, 0.600 [95% CI, 0.561–0.625] versus 0.639 [95% CI, 0.607–0.669]; P=0.025). This model also confirmed an increased sensitivity (integrated discrimination improvement, 5.20%; P<0.001) and positive reclassification (net reclassification improvement, 19.20%; P=0.020). Conclusions: By adding consecutive biomarkers, the predictive ability of CHA2DS2-VASc for ischemic stroke was not increased, whereas the predictive ability of HAS-BLED for major bleeding was only slightly enhanced. The net benefit and clinical usefulness of the biomarker-based models were marginal in comparison to the original scores based on clinical factors.es
dc.formatapplication/pdfes
dc.format.extent8es
dc.identifier.citationStroke. 2019 50:1372-1379
dc.identifier.doihttps://doi.org/10.1161/STROKEAHA.118.024305
dc.identifier.issnPrint: 0039-2499
dc.identifier.issnElectronic: 1524-4628
dc.identifier.urihttp://hdl.handle.net/10201/138841
dc.languageenges
dc.relationInstituto de Salud Carlos III (PI17/01375).es
dc.rights.accessRightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectFibrilación auriculares
dc.subjectBiomarcadoreses
dc.subjectHemorragiaes
dc.subjectEvaluación del riesgoes
dc.subjectIctuses
dc.subjectAtrial fibrillationen
dc.subjectBiomarkersen
dc.subjectHemorrhageen
dc.subjectRisk assessmenten
dc.subjectStrokeen
dc.subject.otherCDU::6 - Ciencias aplicadas::61 - Medicinaes
dc.titleRefining stroke and bleeding prediction in atrial fibrillation by adding consecutive biomarkers to clinical risk scoreses
dc.typeinfo:eu-repo/semantics/articlees
dspace.entity.typePublicationes
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