New Biomarker Score Significantly Improves Atrial Fibrillation Risk Assessment

A new prototype multimarker risk score significantly improved risk assessment for stroke, systemic embolic events, and death compared with traditional atrial fibrillation (AF) risk stratification, according to a recent study.

While the CHA₂DS₂-VASc risk score is widely used in patients with AF to guide treatment decisions, the study authors note that it “has only moderate discrimination.”
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They sought to develop a cardiovascular biomarker score to better analyze risk in these patients. The researchers examined data from the ENGAGE AF-TIMI 48 trial, a randomized double-blind, double-dummy clinical trial comparing 2 once-daily edoxaban dose regimens with warfarin in 21,105 patients with AF.

They randomly assigned 4880 patients to their biomarker substudy, measuring the participants’ cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and D-dimer levels at baseline. Tiered points were assigned based on higher concentrations of the biomarkers.

After adjusting for CHA₂DS₂-VASc score, each biomarker was associated with a 2.8-fold to 4.2-fold gradient of risk comparing the highest vs lowest concentrations. The biomarker risk score identified a more than 15-fold gradient of risk after adjustment. When added to the CHA₂DS₂-VASc score, the biomarker score significantly enhanced accuracy of prognosis.

“A prototype multimarker risk score significantly enhanced risk assessment for stroke, systemic embolic events, or death compared with traditional clinical risk stratification,” the researchers concluded. 

“Incorporation of biomarkers into clinical decision making to define therapeutic management in AF warrants consideration.”

—Michael Potts

Reference:

Ruff CT, Giugliano RP, Braunwald E, et al. Cardiovascular biomarker score and clinical outcomes in patients with atrial fibrillation: a subanalysis of the ENGAGE AF-TIMI 48 randomized clinical trial [published online October 5, 2016]. JAMA Cardiol. doi:10.1001/jamacardio.2016.3311.