A predictive score for atrial fibrillation in poststroke patients

Atrial fibrillation (AF) is a risk factor for cerebral ischemia. Identifying the presence of AF, especially in paroxysmal cases, may take time and lacks clear support in the literature regarding the optimal investigative approach; in resource-limited settings, identifying a higher-risk group for AF can assist in planning further investigation.

Objective

To develop a scoring tool to predict the risk of incident AF in the poststroke follow-up.

Methods

A retrospective longitudinal study with data collected from electronic medical records of patients hospitalized and followed up for cerebral ischemia from 2014 to 2021 at a tertiary stroke center. Demographic, clinical, laboratory, electrocardiogram, and echocardiogram data, as well as neuroimaging data, were collected. Stepwise logistic regression was employed to identify associated variables. A score with integer numbers was created based on beta coefficients. Calibration and validation were performed to evaluate accuracy.

Results

We included 872 patients in the final analysis. The score was created with left atrial diameter ≥ 42 mm (2 points), age ≥ 70 years (1 point), presence of septal aneurysm (2 points), and score ≥ 6 points at admission on the National Institutes of Health Stroke Scale (NIHSS; 1 point). The score ranges from 0 to 6. Patients with a score ≥ 2 points had a fivefold increased risk of having AF detected in the follow-up. The area under the curve (AUC) was of 0.77 (0.72–0.85).

Conclusion

We were able structure an accurate risk score tool for incident AF, which could be validated in multicenter samples in future studies.

Keywords
Ischemic Stroke; Atrial Fibrillation; Prognosis

Variables	Patients (N = 872)	AF detected during follow-up (n = 170)	AF not detected during follow-up (n = 702)	p-value
Age in years: median (IQR)	72 (61–79)	78 (68–84)	70 (59–78)	< 0.001
Male patients: %	50	53.5	49.6	0.56
Weight in kilos: mean ± SD	74.7(±15.2)	74.5(±14.2)	74.9(±15.4)	0.85
NIHSS score upon admission (points): median (IQR)	2 (1–4)	4 (2–7)	2 (0–4)	< 0.001
Neuroimaging
Bilateral involvement: %	11.7	11.9	11.7	0.96
Cortical lesion: %	62.4	11.7	7.2	0.03
Grade on the Fasekas scale: %				0.008
0	8	8.1	7.1
1	34.7	36.4	17.8
2	28.6	28.6	28.5
3	28.6	26.5	46.4
PC-ASPECTS (points): median (IQR)	9 (8–10)	9 (9–10)	9 (8–9)	0.21
ASPECTS (points): median (IQR)	10 (9–10)	9 (9–10)	9 (9–10)	0.71
Laboratory
Blood glucose at admission (mg/dL): median (IQR)	113 (96–142)	118 (101–150)	114 (97–143)	0.30
Platelet count (cells/mm³): median (IQR)	201,000 (169,200–244,600)	187,300 (143,800–243,200)	201,700 (170,900–246,400)	0.03
LDL (mg/dL): mean ± SD	104.1(±39.6)	94.5(±39.9)	106.9(±40.4)	0.01
GFR (mL/min/1.73m²): mean ± SD	73(±33.7)	64(±30.5)	75(±34)	0.03
Comorbidities
Arterial hypertension: %	70.7	70.2	70.9	0.37
Diabetes mellitus: %	32.3	33.3	32.2	0.78
Dyslipidemia: %	46.3	57.1	45	0.08
Coronaropathy: %	12.2	16.6	11.7	0.36
Previous stroke: %	22.4	20.3	22.8	0.67
Prior TIA: %	3	4.8	2.9	0.3
Cardiac measurements
LA size (mm): median (IQR)	38 (34–40)	43 (38–47)	37 (33–40)	< 0.001
LVEF (%): median (IQR)	67 (63–70)	65.5 (58–69)	67 (64–70)	0.004
High number of extrasystoles: %	19.5	21.4	19.2	0.02
Atrial tachycardia: %	2.8	2.8	0	0.15
PFO: %	13.4	6	14.3	0.04
Presence of atrial septal aneurysm: %	3.4	8.4	2.8	0.01
In-hospital treatment, classifications, and outcome
IV thrombolysis: %	10.3	17.8	9.4	0.06
Mechanical thrombectomy: %	3.1	2.4	3.2	0.81
SSS-TOAST undetermined classification: %	26.3	26.5	24.1	0.63
Modified Rankin Scale at discharge (points): median (IQR)	1 (0–2)	1 (0–2)	1 (1–3)	0.008

Variable	Beta-coefficient	OR	95%CI	p-value
Age ≥ 70 years	0.95	2.60	1.46–4.63	0.001
NIHSS score upon admission ≥ 6 points	0.74	2.10	1.20–3.67	0.009
Left atrium size ≥ 42 mm	1.58	4.87	2.89–8.20	< 0.001
Presence of interatrial septal aneurysm	1.56	4.77	1.71–13.25	0.003

Variable	Point
Age ≥ 70 years	1
NIHss score upon admission ≥ 6 points	1
Left atrium size ≥ 42 mm	2
Presence of septal aneurysm	2
Total	0-6

Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence
João Brainer Clares de Andrade (email: joao.brainer@unifesp.br).