A Score for Predicting Paroxysmal Atrial Fibrillation in Acute Stroke Patients: iPAB Score

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• 作者：Kotaro Yoshioka ; MD^&lowast ; ; ^&dagger ; ; ^{kotanuro@tmd.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Kosuke Watanabe ; MD^&dagger ; ; Satoshi Zeniya ; MD^&Dagger ; ; Yoko Ito ; MD^&Dagger ; ; Masaki Hizume ; MD ; PhD^&dagger ; ; Toshiro Kanazawa ; MD ; PhD^&dagger ; ; Makoto Tomita ; PhD^&sect ; ; Satoru Ishibashi ; MD ; PhD^&lowast ; ; Hirotomo Miake ; MD ; PhD^&Dagger ; ; Hiroaki Tanaka ; MD ; PhD^&dagger ; ; Takanori Yokota ; MD ; PhD^&lowast ; ; Hidehiro Mizusawa ; MD ; PhD^&lowast ;
• 关键词：Acute ischemic stroke ; paroxysmal atrial fibrillation ; cardioembolism ; brain natriuretic peptide
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：24
• 期：10
• 页码：2263-2269
• 全文大小：310 K

文摘

Detection of paroxysmal atrial fibrillation (PAF) after a stroke is challenging. The purpose of this study was to develop a clinical score to predict PAF in a cohort of acute ischemic stroke patients prospectively and to validate it in an independent cohort.

ec_2">Methods

Consecutive acute ischemic stroke patients without permanent atrial fibrillation were enrolled in a derivation sample (n = 294) or a validation sample (n = 155). We developed a score for predicting PAF by independent risk factors derived from a logistic regression analysis of the derivation cohort and validated the score in the external cohort.

ec_3">Results

Multivariate analysis in the derivation cohort identified 3 variables independently associated with PAF. We calculated a score from these variables (history of arrhythmia or antiarrhythmic agent use [yes, 3 points], left atrial dilation [&ge;40 mm, 1 point], brain natriuretic peptide [BNP, &ge;50 pg/mL, 1 point; &ge;90 pg/mL, 2 points; &ge;150 pg/ml, 3 points], total score, 0-7). The iPAB score (identified by past history of arrhythmia or antiarrhythmic agent use, atrial dilation, and BNP elevation) predicted PAF in the derivation (<em>cem> statistic, .90) and validation (.94) cohorts at levels statistically superior to other biomarkers and clinical scores. For a total score 2 or more, the sensitivity and specificity were 93% and 71%, respectively. For a total score of 4 or more, the corresponding values were 60% and 95%.

ec_4">Conclusions

Our prospective study suggests that this simple risk score superior to other scores help clinicians predict PAF or identify good candidates for further evaluation to detect PAF.