The PROACTIA score predicted subclinical atrial fibrillation in patients with cryptogenic stroke or TIA, with a prevalence of 75% in the highest versus 10% in the lowest quartile.
Cohort (n=236)
Does the PROACTIA score predict the detection of subclinical atrial fibrillation in patients with cryptogenic stroke or transient ischaemic attack?
The PROACTIA score, utilizing baseline electrocardiographic and echocardiographic parameters, can effectively identify patients with cryptogenic stroke or TIA at high risk for subclinical atrial fibrillation, potentially guiding the targeted use of implantable cardiac monitors.
Absolute Event Rate: 75% vs 10%
AIMS: Studies with implantable cardiac monitors (ICMs) show that one-third of patients with cryptogenic stroke/transient ischaemic attack (TIA) have episodes of subclinical atrial fibrillation (SCAF) and benefit switching from antiplatelet- to anticoagulant therapy. However, ICMs are costly and resource demanding. We aimed to build a score based on participant's baseline characteristics that could assess individual risk of SCAF. METHODS AND RESULTS: In a prospective study, 236 eligible patients with a final diagnosis of cryptogenic stroke/TIA had an ICM implantated during the index hospitalization. Pre-specified evaluated variables were: CHA2DS2-VASc, P-wave duration, P-wave morphology, premature atrial beats (PAC)/24 h, supraventricular tachycardia/24 h, left atrial end-systolic volume index (LAVI), Troponin-T, NT-proBNP, and D-dimer. SCAF was detected in 84 patients (36%). All pre-specified variables were significantly associated with SCAF detection in univariate analysis. P-wave duration, followed by PAC/24 h, NT-proBNP, and LAVI, had the largest ratio of SCAF prevalence between its upper and lower quartiles (3.3, vs. 3.2, vs. 3.1 vs. 2.8, respectively). However, in a multivariate analysis, only PAC/24t, P-wave duration, P-wave morphology, and LAVIs remained significant predictors and were included in the PROACTIA score. Subclinical atrial fibrillation prevalence was 75% in the highest vs. 10% in the lowest quartile of the PROACTIA score with a 10-fold higher number of patients with an atrial fibrillation burden >6 h in the highest vs. the lowest quartile. CONCLUSION: The PROACTIA score can identify patients with cryptogenic stroke/TIA at risk of subsequent SCAF detection. The large difference in SCAF prevalence between groups may provide a basis for future tailored therapy. CLINICAL TRIAL REGISTRATION: Clinical Trial Registration: ClinicalTrials.gov; NCT02725944.
Skrebelyte-Strøm et al. (Tue,) conducted a cohort in Cryptogenic stroke and transient ischaemic attack (n=236). PROACTIA score (highest quartile) vs. PROACTIA score (lowest quartile) was evaluated on Detection of subclinical atrial fibrillation (SCAF). The PROACTIA score predicted subclinical atrial fibrillation in patients with cryptogenic stroke or TIA, with a prevalence of 75% in the highest versus 10% in the lowest quartile.