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(Stroke. 2007;38:2409.)
© 2007 American Heart Association, Inc.

Editorials

Predicting Stroke Risk in Patients With Atrial Fibrillation

Daniel G. Hackam, MD, PhD, FRCPC

From the Divisions of Clinical Pharmacology and Clinical Neurological Sciences, and Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada.

Correspondence to Daniel G. Hackam, 1400 Western Road, London, Ontario, Canada N6G 2V2. E-mail dhackam@uwo.ca

Key Words: anticoagulation • atrial fibrillation • prognosis • risk factors

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 2459–2463.

Predicting which patients with atrial fibrillation will have a stroke or systemic embolic event is not an easy task. In this issue of Stroke, Lawrence Baruch and colleagues retrospectively compared 7 risk stratification schemes in a large clinical trial–based program of patients with atrial fibrillation (the Stroke Prevention using an ORal Thrombin Inhibitor in atrial Fibrillation [SPORTIF] III and IV studies).¹ As assessed by the concordance (or C) statistic, which measures the area under a test’s receiver-operating characteristic curve, all prediction schemes performed rather modestly, with the best C statistic belonging to the CHADS₂ scheme (C=0.65).

At first glance, these data might suggest caution regarding the use of formal risk stratification schemes to predict stroke in patients with atrial fibrillation. However, many potential caveats apply. In much of the original validation work for such schemes, patients were not selected by the presence of additional risk factors such as hypertension or heart failure, whereas in the SPORTIF program, only patients with atrial fibrillation judged to be at high risk because of the presence of concomitant stroke risk factors were included.^2,3 Therefore, as recognized by the authors, the present study included few patients at low risk for stroke, thereby hampering the ability of the stratification schemes to separate patients on the basis of predicted risk. Clinical trials are often criticized because they include patients at the extreme lower end of the risk spectrum, but the converse is actually true in this case, . . . [Full Text of this Article]

Related Article:

Can Patients at Elevated Risk of Stroke Treated With Anticoagulants Be Further Risk Stratified?

Lawrence Baruch, Brian F. Gage, Jay Horrow, Steen Juul-Möller, Arthur Labovitz, Maria Persson, and Miguel Zabalgoitia
Stroke 2007 38: 2459-2463. [Abstract] [Full Text] [PDF]