Key result
iPAB score best predicts post-stroke paroxysmal AF with an AUC of ~0.83.
Why the study?
Detection of paroxysmal atrial fibrillation is crucial for secondary prevention after stroke of unknown etiology, but the predictive power of available risk scores needed evaluation.
Do clinical risk scores accurately predict the detection of new paroxysmal atrial fibrillation in patients with acute ischemic stroke or TIA?
Meta-Analysis
Do clinical risk scores accurately predict the detection of new paroxysmal atrial fibrillation in patients with acute ischemic stroke or TIA?
Available clinical risk scores demonstrate moderate to good predictive accuracy and can help tailor the use of extended cardiac monitoring for detecting paroxysmal atrial fibrillation after acute ischemic stroke.
Answers are grounded in this paper and cite their sources.
Supports tailoring extended monitoring after ischemic stroke; confirms risk scores' utility, especially iPAB, for paroxysmal AF prediction.
Introduction: Detection of paroxysmal atrial fibrillation (PAF) is crucial for secondary prevention in patients with recent strokes of unknown etiology. This systematic review and meta-analysis assess the predictive power of available risk scores for detecting new PAF after acute ischemic stroke (AIS). Methods: PubMed, Embase, Scopus, and Web of Science databases were searched until September 2023 to identify relevant studies. A bivariate random effects meta-analysis model pooled data on sensitivity, specificity, and area under the curve (AUC) for each score. The QUADAS-2 tool was used for the quality assessment. Results: Eventually, 21 studies with 18 original risk scores were identified. Age, left atrial enlargement, and NIHSS score were the most common predictive factors, respectively. Seven risk scores were meta-analyzed, with iPAB showing the highest pooled sensitivity and AUC (sensitivity: 89.4%, specificity: 74.2%, AUC: 0.83), and HAVOC having the highest pooled specificity (sensitivity: 46.3%, specificity: 82.0%, AUC: 0.82). Altogether, seven risk scores displayed good discriminatory power (AUC ≥0.80) with four of them (HAVOC, iPAB, Fujii, and MVP scores) being externally validated. Conclusion: Available risk scores demonstrate moderate to good predictive accuracy and can help identify patients who would benefit from extended cardiac monitoring after AIS. External validation is essential before widespread clinical adoption.
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Kazemian et al. (2024) conducted a meta-analysis in Acute ischemic stroke or transient ischemic attack without prior atrial fibrillation. Clinical risk scores (e.g., iPAB, HAVOC, STAF) was evaluated on Discriminatory power for detecting new paroxysmal atrial fibrillation (pooled Area Under the Curve for iPAB score) (AUC 0.83). Several risk scores displayed good discriminatory power for predicting paroxysmal atrial fibrillation after acute ischemic stroke, with the iPAB score demonstrating the highest pooled sensitivity and AUC.
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