Researchers have developed a risk score to predict stroke likelihood in patients with MI and HF and/or systolic dysfunction who do not present with atrial fibrillation.
The researchers analyzed data from the CAPRICORN, OPTIMAAL, VALIANT and EPHESUS trials that included 22,904 patients (mean age, 64 years; 30% women) with MI and HF and/or left ventricular systolic dysfunction but no AF or oral anticoagulation use.
Those from CAPRICORN, OPTIMAAL and VALIANT were used as the derivation cohort and those from EPHESUS were used as the validation cohort to develop the model.
The primary outcome was stroke, with death considered a competing risk. Median follow-up was 1.9 years, during which 2.9% of patients had a stroke.
Compared with those who did not have a stroke, those who did were older, more likely to be women, smokers and hypertensive; had a higher Killip class; had a lower estimated glomerular filtration rate (eGFR); and were more likely to have prior MI, HF, diabetes and stroke, João Pedro Ferreira, MD, PhD, postdoctoral research fellow at INSERM, Centre d'Investigation Clinique Plurithématiques de Nancy, France, and colleagues wrote.
Ferreira and colleagues found that the following factors were independently associated with stroke risk, and included them in the model:
- older age (2 points for age 60-75 years; 3 points for age > 75 years);
- Killip class II or IV (1 point);
- eGFR 30 mL/min/1.73 m2 to 45 mL/min/1.73 m2 (1 point);
- hypertension (1 point); and
- previous stroke (3 points).
The models showed good discrimination (C-index = 0.67) and were well-calibrated, according to the researchers.
When the cohort was stratified into sextiles by risk score, 3-year stroke event rate increased steeply from lowest sextile to highest (lowest, 1.8%; second-lowest, 2.9%; third-lowest, 4.1%; third-highest, 5.6%; second-highest, 8.3%; highest, 10.9%), the researchers wrote.
“This risk score may help in the identification of patients with MI and HF and a high risk for stroke despite their not presenting with AF,” Ferreira and colleagues wrote.
In a related editorial, Ronald S. Freudenberger, MD, MBA, from the Lehigh Valley Hospital and Health Network Heart Institute, Allentown, Pennsylvania, wrote: “These risk tools may be helpful but certainly must be used with caution and proper training as with any other tool. As tools, they should be used to help inform clinical decision-making, not become the absolute arbiter.” – by Erik Swain
Ferreira reports he has received board membership fees from Novartis; speaker fees from Roche; and is a co-founder of CardioRenal. Please see the study for all other authors’ relevant financial disclosures. Freudenberger reports no relevant financial disclosures.