Key result
A dynamic nomogram incorporating age, baseline NIHSS score, early NOAC introduction, and pneumonia accurately predicted 3-month mortality in acute ischemic stroke patients with atrial fibrillation (training cohort AUC 0.851, validation cohort AUC 0.811).
Why the study?
Acute ischemic stroke in patients with AF carries a substantial risk of mortality, creating a need for effective risk assessment tools to predict 3-month mortality.
Does a dynamic nomogram accurately predict 3-month mortality in patients with acute ischemic stroke and atrial fibrillation?
Cohort (n=412)
No
Does a dynamic nomogram accurately predict 3-month mortality in patients with acute ischemic stroke and atrial fibrillation?
Effect estimate: AUC 0.851 (95% CI 0.802-0.899)
A novel dynamic nomogram incorporating age, NIHSS score, early NOAC use, and pneumonia provides good discrimination for predicting 3-month mortality in patients with acute ischemic stroke and atrial fibrillation.
May aid 3-month mortality stratification in AIS with AF; leaves open prospective validation before clinical use.
Background: Acute ischemic stroke (AIS) in patients with atrial fibrillation (AF) carries a substantial risk of mortality, emphasizing the need for effective risk assessment and timely interventions. This study aimed to develop and validate a practical dynamic nomogram for predicting 3-month mortality in AIS patients with AF. Methods: AIS patients with AF were enrolled and randomly divided into training and validation cohorts. The nomogram was developed based on independent risk factors identified by multivariate logistic regression analysis. The prediction performance of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC-ROC), calibration plots, decision curve analysis (DCA), and Kaplan-Meier survival analysis. Results: A total of 412 patients with AIS and AF entered final analysis, 288 patients in the training cohort and 124 patients in the validation cohort. The nomogram was developed using age, baseline National Institutes of Health Stroke Scale score, early introduction of novel oral anticoagulants, and pneumonia as independent risk factors. The nomogram exhibited good discrimination both in the training cohort (AUC, 0.851; 95% CI, 0.802-0.899) and the validation cohort (AUC, 0.811; 95% CI, 0.706-0.916). The calibration plots, DCA and Kaplan-Meier survival analysis demonstrated that the nomogram was well calibrated and clinically useful, effectively distinguishing the 3-month survival status of patients with AIS and AF, respectively. The dynamic nomogram can be obtained at the website: https://yanxiaodi.shinyapps.io/3-monthmortality/. Conclusion: The dynamic nomogram represents the first predictive model for 3-month mortality and may contribute to managing the mortality risk of patients with AIS and AF.
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Yan et al. (2024) conducted a cohort in Acute Ischemic Stroke with Atrial Fibrillation (n=412). Dynamic nomogram was evaluated on 3-month mortality prediction (AUC in training cohort) (AUC 0.851, 95% CI 0.802-0.899). A dynamic nomogram incorporating age, baseline NIHSS score, early NOAC introduction, and pneumonia accurately predicted 3-month mortality in acute ischemic stroke patients with atrial fibrillation (training cohort AUC 0.851, validation cohort AUC 0.811).
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