Key result
C2HEST score outperforms CHA2DS2-VASc and other scores for detecting underlying AF in cryptogenic stroke.
Why the study?
AF is a frequent cause of cryptogenic stroke and detection increases with ICM, but the diagnostic ability of different risk scores to identify underlying AF on ICM required evaluation.
Does the C2HEST score better predict the detection of atrial fibrillation compared to CHA2DS2-VASc, HAVOC, and Brown ESUS-AF scores in patients with cryptogenic stroke receiving implantable cardiac monitoring?
Cohort (n=250)
No
Does the C2HEST score better predict the detection of atrial fibrillation compared to CHA2DS2-VASc, HAVOC, and Brown ESUS-AF scores in patients with cryptogenic stroke receiving implantable cardiac monitoring?
Effect estimate: C statistic 0.770 (95% CI 0.699-0.839)
p-value: p=<0.05
The C2HEST score outperforms CHA2DS2-VASc, HAVOC, and Brown ESUS-AF scores in identifying patients with cryptogenic stroke who have underlying atrial fibrillation detected by implantable cardiac monitoring.
May aid AF risk stratification in cryptogenic stroke; hypothesis-generating and requires prospective validation.
BACKGROUND: Atrial fibrillation (AF) is a frequent underlying cause of cryptogenic stroke (CS) and its detection can be increased using implantable cardiac monitoring (ICM). We sought to evaluate different risk scores and assess their diagnostic ability in identifying patients with CS with underlying AF on ICM. METHODS: Patients with CS, being admitted to a single tertiary stroke center between 2017 and 2022 and receiving ICM, were prospectively evaluated. The CHA 2 DS 2 -VASc, HAVOC, Brown ESUS-AF, and C 2 HEST scores were calculated at baseline. The primary outcome of interest was the detection of AF, which was defined as at least 1 AF episode on ICM lasting for 2 consecutive minutes or more. The diagnostic accuracy measures and the net reclassification improvement were calculated for the 4 risk scores. Stroke recurrence was evaluated as a secondary outcome. RESULTS: A total of 250 patients with CS were included, and AF was detected by ICM in 20.4% (n=51) during a median monitoring period of 16 months. Patients with CS with AF detection were older compared with the rest ( P =0.045). The median HAVOC, Brown ESUS-AF, and C 2 HEST scores were higher among the patients with AF compared with the patients without AF (all P <0.05), while the median CHA 2 DS 2 -VASc score was similar between the 2 groups. The corresponding C statistics for CHA 2 DS 2 -VASc, HAVOC, Brown ESUS-AF, and C 2 HEST for AF prediction were 0.576 (95% CI, 0.482–0.670), 0.612 (95% CI, 0.523–0.700), 0.666 (95% CI, 0.587–0.746), and 0.770 (95% CI, 0.699–0.839). The C 2 HEST score presented the highest diagnostic performance based on C statistics ( P <0.05 after correction for multiple comparisons) and provided significant improvement in net reclassification for AF detection (>70%) compared with the other risk scores. Finally, stroke recurrence was documented in 5.6% of the study population, with no difference regarding the 4 risk scores between patients with and without recurrent stroke. CONCLUSIONS: The C 2 HEST score was superior to the CHA 2 DS 2 -VASc, HAVOC, and Brown ESUS-AF scores for discriminating patients with CS with underlying AF using ICM.
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Palaiodimou et al. (2024) conducted a cohort in Cryptogenic stroke (n=250). C2HEST score vs. CHA2DS2-VASc, HAVOC, and Brown ESUS-AF scores was evaluated on Detection of AF (at least 1 AF episode on ICM lasting for 2 consecutive minutes or more) (C statistic 0.770, 95% CI 0.699-0.839, p=<0.05). The C2HEST score was superior to CHA2DS2-VASc, HAVOC, and Brown ESUS-AF scores for discriminating underlying AF in cryptogenic stroke patients (C statistic 0.770; 95% CI 0.699-0.839; P<0.05).
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