The C2HEST, Brown ESUS-AF, and AS5F scoring systems reliably predicted incident atrial fibrillation in patients with cryptogenic stroke or TIA, with AUCs of 0.704, 0.755, and 0.726, respectively.
Observational (n=132)
Do published scoring systems accurately predict incident atrial fibrillation in patients with cryptogenic stroke or TIA?
The C2HEST, Brown ESUS-AF, and AS5F scoring systems reliably predict incident atrial fibrillation in patients with cryptogenic stroke or TIA, potentially guiding the targeted use of implantable cardiac monitors.
BACKGROUND: Atrial fibrillation (AF) is a common but often undetected cause of cryptogenic stroke (CS) and embolic stroke of undetermined source (ESUS). Implantable cardiac monitors aid in detecting subclinical AF, but their widespread use is limited by cost and logistical challenges. Several scoring systems exist to predict AF in patients with CS/ESUS, though few have been externally validated. This study was designed to externally validate 7 scoring systems for predicting incident AF in patients with CS/ESUS. METHODS: In this observational study, we analyzed 132 patients with CS or transient ischemic attack who received implantable cardiac monitors. After a comprehensive literature search, 7 prediction models (Coronary Artery Disease or Chronic Obstructive Pulmonary Disease, Hypertension, Elderly, Systolic Heart Failure, Thyroid Disease C2HEST, Brown ESUS-AF, ESUS-AF, Hypertension, Age, Valvular Heart Disease, Peripheral Vascular Disease, Obesity, Congestive Heart Failure, Coronary Artery Disease HAVOC, Age, Hypercholesterolemia, Tricuspid Regurgitation, Left Ventricular End-Diastolic Volume, Left Atrium ACTEL, Age, Stroke Severity, National Institutes of Health Stroke Scale >5 to Find Atrial Fibrillation AS5F, and Coronary, Heart Failure, Age, Stroke Severity, Lipidemia, Sugar, Prior Stroke CHASE-LESS) were applied. The primary outcome was the discriminatory ability to detect AF. Secondary outcomes included evaluating the threshold scores and the performance of such threshold-based criteria for predicting nonoccurrence of AF with high specificity. RESULTS: AF was detected in 40 patients (30.3%) over a mean follow-up of 13±12 months. Area under the receiver operating characteristic curves were C2HEST (0.704), Brown ESUS-AF (0.755), AS5F (0.726), ESUS-AF (0.607), HAVOC (0.661), ACTEL (0.650), and CHASE-LESS (0.671). C2HEST, Brown ESUS-AF, and AS5F showed acceptable predictive performance (area under the receiver operating characteristic curve >0.7). Threshold-based criteria using these scores achieved high specificity and positive predictive value. Combining thresholds across scores improved identification of patients unlikely to develop AF. CONCLUSIONS: C2HEST, Brown ESUS-AF, and AS5F scores reliably predicted AF in patients with CS/ESUS and may help identify low-risk individuals, supporting more targeted use of diagnostic tools and guiding stroke prevention strategies.
Pinnacchio et al. (Tue,) conducted a observational in Cryptogenic stroke or transient ischemic attack (n=132). Scoring systems to predict incident AF (C2HEST, Brown ESUS-AF, AS5F, etc.) was evaluated on Discriminatory ability to detect AF. The C2HEST, Brown ESUS-AF, and AS5F scoring systems reliably predicted incident atrial fibrillation in patients with cryptogenic stroke or TIA, with AUCs of 0.704, 0.755, and 0.726, respectively.
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