A simple and easily implemented risk model to predict 1-year ischemic stroke and systemic embolism in Chinese patients with atrial fibrillation
Abstract. Background:. Accurate prediction of ischemic stroke is required for deciding anticoagulation use in patients with atrial fibrillation (AF). Even though only 6% to 8% of AF patients die from stroke, about 90% are indicated for anticoagulants according to the current AF management guidelines...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2021-10-01
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| Series: | Chinese Medical Journal |
| Online Access: | http://journals.lww.com/10.1097/CM9.0000000000001515 |
| _version_ | 1818985640655585280 |
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| author | Chao Jiang Tian-Ge Chen Xin Du Xiang Li Liu He Yi-Wei Lai Shi-Jun Xia Rong Liu Yi-Ying Hu Ying-Xue Li Chen-Xi Jiang Nian Liu Ri-Bo Tang Rong Bai Cai-Hua Sang De-Yong Long Guo-Tong Xie Jian-Zeng Dong Chang-Sheng Ma Jing Ni |
| author_facet | Chao Jiang Tian-Ge Chen Xin Du Xiang Li Liu He Yi-Wei Lai Shi-Jun Xia Rong Liu Yi-Ying Hu Ying-Xue Li Chen-Xi Jiang Nian Liu Ri-Bo Tang Rong Bai Cai-Hua Sang De-Yong Long Guo-Tong Xie Jian-Zeng Dong Chang-Sheng Ma Jing Ni |
| author_sort | Chao Jiang |
| collection | DOAJ |
| description | Abstract. Background:. Accurate prediction of ischemic stroke is required for deciding anticoagulation use in patients with atrial fibrillation (AF). Even though only 6% to 8% of AF patients die from stroke, about 90% are indicated for anticoagulants according to the current AF management guidelines. Therefore, we aimed to develop an accurate and easy-to-use new risk model for 1-year thromboembolic events (TEs) in Chinese AF patients.
Methods:. From the prospective China Atrial Fibrillation Registry cohort study, we identified 6601 AF patients who were not treated with anticoagulation or ablation at baseline. We selected the most important variables by the extreme gradient boosting (XGBoost) algorithm and developed a simplified risk model for predicting 1-year TEs. The novel risk score was internally validated using bootstrapping with 1000 replicates and compared with the CHA2DS2-VA score (excluding female sex from the CHA2DS2-VASc score).
Results:. Up to the follow-up of 1 year, 163 TEs (ischemic stroke or systemic embolism) occurred. Using the XGBoost algorithm, we selected the three most important variables (congestive heart failure or left ventricular dysfunction, age, and prior stroke, abbreviated as CAS model) to predict 1-year TE risk. We trained a multivariate Cox regression model and assigned point scores proportional to model coefficients. The CAS scheme classified 30.8% (2033/6601) of the patients as low risk for TE (CAS score = 0), with a corresponding 1-year TE risk of 0.81% (95% confidence interval [CI]: 0.41%–1.19%). In our cohort, the C-statistic of CAS model was 0.69 (95% CI: 0.65–0.73), higher than that of CHA2DS2-VA score (0.66, 95% CI: 0.62–0.70, Z = 2.01, P = 0.045). The overall net reclassification improvement from CHA2DS2-VA categories (low = 0/high ≥1) to CAS categories (low = 0/high ≥1) was 12.2% (95% CI: 8.7%–15.7%).
Conclusion:. In Chinese AF patients, a novel and simple CAS risk model better predicted 1-year TEs than the widely-used CHA2DS2-VA risk score and identified a large proportion of patients with low risk of TEs, which could potentially improve anticoagulation decision-making.
Trial Registration:. www.chictr.org.cn (Unique identifier No. ChiCTR-OCH-13003729). |
| first_indexed | 2024-12-20T18:38:07Z |
| format | Article |
| id | doaj.art-a478ddc0455b474aa71e36e1c539b66b |
| institution | Directory Open Access Journal |
| issn | 0366-6999 2542-5641 |
| language | English |
| last_indexed | 2024-12-20T18:38:07Z |
| publishDate | 2021-10-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Chinese Medical Journal |
| spelling | doaj.art-a478ddc0455b474aa71e36e1c539b66b2022-12-21T19:29:53ZengWolters KluwerChinese Medical Journal0366-69992542-56412021-10-01134192293229810.1097/CM9.0000000000001515202110050-00006A simple and easily implemented risk model to predict 1-year ischemic stroke and systemic embolism in Chinese patients with atrial fibrillationChao JiangTian-Ge ChenXin DuXiang LiLiu HeYi-Wei LaiShi-Jun XiaRong LiuYi-Ying HuYing-Xue LiChen-Xi JiangNian LiuRi-Bo TangRong BaiCai-Hua SangDe-Yong LongGuo-Tong XieJian-Zeng DongChang-Sheng MaJing NiAbstract. Background:. Accurate prediction of ischemic stroke is required for deciding anticoagulation use in patients with atrial fibrillation (AF). Even though only 6% to 8% of AF patients die from stroke, about 90% are indicated for anticoagulants according to the current AF management guidelines. Therefore, we aimed to develop an accurate and easy-to-use new risk model for 1-year thromboembolic events (TEs) in Chinese AF patients. Methods:. From the prospective China Atrial Fibrillation Registry cohort study, we identified 6601 AF patients who were not treated with anticoagulation or ablation at baseline. We selected the most important variables by the extreme gradient boosting (XGBoost) algorithm and developed a simplified risk model for predicting 1-year TEs. The novel risk score was internally validated using bootstrapping with 1000 replicates and compared with the CHA2DS2-VA score (excluding female sex from the CHA2DS2-VASc score). Results:. Up to the follow-up of 1 year, 163 TEs (ischemic stroke or systemic embolism) occurred. Using the XGBoost algorithm, we selected the three most important variables (congestive heart failure or left ventricular dysfunction, age, and prior stroke, abbreviated as CAS model) to predict 1-year TE risk. We trained a multivariate Cox regression model and assigned point scores proportional to model coefficients. The CAS scheme classified 30.8% (2033/6601) of the patients as low risk for TE (CAS score = 0), with a corresponding 1-year TE risk of 0.81% (95% confidence interval [CI]: 0.41%–1.19%). In our cohort, the C-statistic of CAS model was 0.69 (95% CI: 0.65–0.73), higher than that of CHA2DS2-VA score (0.66, 95% CI: 0.62–0.70, Z = 2.01, P = 0.045). The overall net reclassification improvement from CHA2DS2-VA categories (low = 0/high ≥1) to CAS categories (low = 0/high ≥1) was 12.2% (95% CI: 8.7%–15.7%). Conclusion:. In Chinese AF patients, a novel and simple CAS risk model better predicted 1-year TEs than the widely-used CHA2DS2-VA risk score and identified a large proportion of patients with low risk of TEs, which could potentially improve anticoagulation decision-making. Trial Registration:. www.chictr.org.cn (Unique identifier No. ChiCTR-OCH-13003729).http://journals.lww.com/10.1097/CM9.0000000000001515 |
| spellingShingle | Chao Jiang Tian-Ge Chen Xin Du Xiang Li Liu He Yi-Wei Lai Shi-Jun Xia Rong Liu Yi-Ying Hu Ying-Xue Li Chen-Xi Jiang Nian Liu Ri-Bo Tang Rong Bai Cai-Hua Sang De-Yong Long Guo-Tong Xie Jian-Zeng Dong Chang-Sheng Ma Jing Ni A simple and easily implemented risk model to predict 1-year ischemic stroke and systemic embolism in Chinese patients with atrial fibrillation Chinese Medical Journal |
| title | A simple and easily implemented risk model to predict 1-year ischemic stroke and systemic embolism in Chinese patients with atrial fibrillation |
| title_full | A simple and easily implemented risk model to predict 1-year ischemic stroke and systemic embolism in Chinese patients with atrial fibrillation |
| title_fullStr | A simple and easily implemented risk model to predict 1-year ischemic stroke and systemic embolism in Chinese patients with atrial fibrillation |
| title_full_unstemmed | A simple and easily implemented risk model to predict 1-year ischemic stroke and systemic embolism in Chinese patients with atrial fibrillation |
| title_short | A simple and easily implemented risk model to predict 1-year ischemic stroke and systemic embolism in Chinese patients with atrial fibrillation |
| title_sort | simple and easily implemented risk model to predict 1 year ischemic stroke and systemic embolism in chinese patients with atrial fibrillation |
| url | http://journals.lww.com/10.1097/CM9.0000000000001515 |
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