The novel CAS risk model better predicted 1-year thromboembolic events than the CHA2DS2-VA score (C-statistic 0.69 vs 0.66; P=0.045) in Chinese patients with atrial fibrillation.
Cohort (n=6,601)
Does the CAS risk model better predict 1-year thromboembolic events compared to the CHA2DS2-VA score in Chinese patients with atrial fibrillation?
A novel, simplified CAS risk model (CHF/LVD, age, prior stroke) better predicts 1-year thromboembolic events than the CHA2DS2-VA score in Chinese AF patients, potentially improving anticoagulation decision-making.
Estimación del efecto: C-statistic 0.69 (95% CI 0.65-0.73)
Tasa de eventos absoluta: 0.69% vs 0.66%
valor p: p=0.045
BACKGROUND: Accurate prediction of ischemic stroke is required for deciding anticoagulation use in patients with atrial fibrillation (AF). Even though only 6% to 8% of AF patients die from stroke, about 90% are indicated for anticoagulants according to the current AF management guidelines. Therefore, we aimed to develop an accurate and easy-to-use new risk model for 1-year thromboembolic events (TEs) in Chinese AF patients. METHODS: From the prospective China Atrial Fibrillation Registry cohort study, we identified 6601 AF patients who were not treated with anticoagulation or ablation at baseline. We selected the most important variables by the extreme gradient boosting (XGBoost) algorithm and developed a simplified risk model for predicting 1-year TEs. The novel risk score was internally validated using bootstrapping with 1000 replicates and compared with the CHA2DS2-VA score (excluding female sex from the CHA2DS2-VASc score). RESULTS: Up to the follow-up of 1 year, 163 TEs (ischemic stroke or systemic embolism) occurred. Using the XGBoost algorithm, we selected the three most important variables (congestive heart failure or left ventricular dysfunction, age, and prior stroke, abbreviated as CAS model) to predict 1-year TE risk. We trained a multivariate Cox regression model and assigned point scores proportional to model coefficients. The CAS scheme classified 30.8% (2033/6601) of the patients as low risk for TE (CAS score = 0), with a corresponding 1-year TE risk of 0.81% (95% confidence interval CI: 0.41%-1.19%). In our cohort, the C-statistic of CAS model was 0.69 (95% CI: 0.65-0.73), higher than that of CHA2DS2-VA score (0.66, 95% CI: 0.62-0.70, Z = 2.01, P = 0.045). The overall net reclassification improvement from CHA2DS2-VA categories (low = 0/high ≥1) to CAS categories (low = 0/high ≥1) was 12.2% (95% CI: 8.7%-15.7%). CONCLUSION: In Chinese AF patients, a novel and simple CAS risk model better predicted 1-year TEs than the widely-used CHA2DS2-VA risk score and identified a large proportion of patients with low risk of TEs, which could potentially improve anticoagulation decision-making. TRIAL REGISTRATION: www.chictr.org.cn (Unique identifier No. ChiCTR-OCH-13003729).
Jiang et al. (Tue,) conducted a cohort in Atrial fibrillation (n=6,601). CAS risk model vs. CHA2DS2-VA score was evaluated on 1-year thromboembolic events (ischemic stroke or systemic embolism) prediction (C-statistic) (C-statistic 0.69, 95% CI 0.65-0.73, p=0.045). The novel CAS risk model better predicted 1-year thromboembolic events than the CHA2DS2-VA score (C-statistic 0.69 vs 0.66; P=0.045) in Chinese patients with atrial fibrillation.