Introduction
Methods
Study design and outcomes
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AS5F score calculated as Age × 0.76 + National Institutes of Health Stroke Scale (NIHSS) ≤ 5 (9 points) or > 5 (21 points). The threshold of 67.5 points reflects the AF risk of 5.2% (Number Needed to Screen, NNS ≤ 20). Area under the receiver operating characteristic curve (AUC) 0.75. Online calculator available at www.unimedizin-mainz.de/neurologie/header/as5f.html. [15]
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Brown ESUS-AF score calculated according to age (65–74 years: 1 point, ≥ 75 years: 2 points) and left atrium (LA) enlargement (moderate or severe: 2 points). Possible total score 0–4. AUC 0.725. For the score of 2 sensitivity 62.9%, specificity 70.6% [16].
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CHA2DS2-VASc calculated as 1 point each congestive heart failure, hypertension, diabetes, vascular disease, sex (female) and age (65–74), and 2 points for age ≥ 75 years and prior stroke/TIA. Possible score 0–9. C-index 0.62 [17].
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CHASE-LESS score calculated as coronary artery disease (1 point), heart failure (1 point), age (1 point for every 10 years), stroke severity (1 point for NIHSS 6–13, 4 points for ≥ 14), hyperlipidaemia (− 1 point), diabetes (− 1 point), prior stroke/TIA (-1 point). Possible score 1–15. The likelihood of underlying AF categorized as low (1–3), low intermediate (4–6), high intermediate (7–9), high (≥ 10). C-index 0.730 [18].
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HAVOC score calculated as 1 point each for peripheral vascular disease and obesity (body mass index > 30); 2 points each for hypertension, age ≥ 75 years, valvular heart disease, and coronary disease; 4 points for congestive heart failure. Possible score 0–14. Stratifies patients into three risk groups, low (0–4), medium (5–9) and high (10–14) risk. AUC 0.77. For the score ≥ 4 sensitivity 35%, specificity 82.8%, positive predictive value (PPV) 31.8%, negative predictive value (NPV) 84.7% [21, 22].
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STAF score calculated from the sum of the points for the 4 items: age > 62 years (2 points), NIHSS ≥ 8 (1 point), LA dilatation (2 points), absence of symptomatic extra- or intracranial stenosis ≥ 50% or clinic-radiological lacunar syndrome (3 points). Possible total score 0–8. AUC 0.94. The STAF score ≥ 5 identifies patients with AF with a sensitivity of 89% and a specificity of 88% [23].
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SURF score calculated as Age × 10 + brain natriuretic peptide (BNP) (ng/l) in the acute phase > 700. CS patients in the NOR-FIB study fulfilled SURF criteria (AF-naive stroke without indication of long-term OAC, no symptomatic atherosclerotic stenosis ≥ 50%, symptomatic arterial dissection or lacunar stroke). AUC 0.842. PPV 47.7%. NPV 96.8% [24].
Statistical analysis
Results
Pres-stroke demographics and comorbidity, n = 259 | AF group | non-AF group | p value |
---|---|---|---|
n = 74 | n = 185 | ||
Age (y), mean (SD) | 72.6 (9.7) | 62.2 (12.5) | < 0.001 |
Age categories, years n (%): | < 0.001 | ||
< 65 | 11 (14.9) | 98 (53.0) | |
65–74 | 32 (43.2) | 56 (30.3) | |
≥ 75 | 31 (41.9) | 31 (16.8) | |
Female sex, n (%) | 30 (40.5) | 78 (42.2) | 0.811 |
AF risk factors, n (%): | |||
Heart failurea | 1 (1.4) | 2 (1.1) | 1 |
Hypertensiona | 45 (60.8) | 87 (47.0) | 0.045 |
Diabetes mellitusa | 6 (8.1) | 16 (8.6) | 0.888 |
Prior ischaemic stroke or TIAa | 18 (24.3) | 41 (22.2) | 0.708 |
Haemorrhagic strokea | 1 (1.4) | 0 (0.0) | 0.286 |
Vascular diseasea | 8 (10.8) | 14 (7.6) | 0.398 |
Dyslipidaemiaa | 32 (43.2) | 47 (25.4) | 0.005 |
Myocardial infarctiona | 4 (5.4) | 11 (5.9) | 1 |
Renal failurea | 5 (6.8) | 9 (4.9) | 0.55 |
COPDa | 5 (6.8) | 5 (2.7) | 0.155 |
Cancerb | 6 (8.1) | 11 (5.9) | 0.581 |
Current smokingc | 8 (10.8) | 49 (26.5) | 0.006 |
Antiarrhythmic drugs usaged | 21 (28.4) | 23 (12.4) | 0.002 |
Echocardiographic findings at enrollment, n (%) | |||
LV hypertrophy, n = 234 | 50 (73.5) | 95 (57.2) | 0.020 |
Reduced EFe, n = 242 | 6 (8.3) | 8 (4.7) | 0.365 |
Valvular diseasef, n = 258 | 30 (40.5) | 47 (25.5) | 0.017 |
LA enlargement, n = 227 | 28 (45.1) | 60 (36.4) | 0.251 |
Mild | 10 (16.1) | 25 (15.2) | |
Moderate | 10 (16.1) | 13 (7.9) | |
Severe | 8 (12.9) | 22 (13.3) | |
Discharge characteristics, n (%) | |||
Heart failure | 4 (5.4) | 4 (2.2) | 0.230 |
Hypertension | 47 (63.5) | 98 (53) | 0.123 |
Diabetes mellitus | 7 (9.5) | 17 (9.2) | 0.946 |
Prior ischaemic stroke or TIAg | 41 (55.4) | 81 (43.8) | 0.091 |
Vascular disease | 9 (12.2) | 17 (9.2) | 0.472 |
Dyslipidaemia | 37 (50.0) | 72 (38.9) | 0.103 |
Renal failure | 6 (8.1) | 13 (7.0) | 0.763 |
CHA2DS2-VASc median, (IQR) | 5 (4–6) | 4 (3–5) | < 0.001 |
Predictor | All | With AF | Univariate OR (95% CI) | Multivariate OR (95% CI) | |
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n | % | ||||
Female | 108 | 30 | 27.8 | Reference | Reference |
Male sex | 151 | 44 | 29.1 | 1.07 (0.62–1.85) | 1.33 (0.68–2.59) |
Age, y | |||||
< 65 | 109 | 11 | 10.1 | Reference | Reference |
65–74 | 88 | 32 | 36.4 | 5.09 (2.38–10.88) | 3.72 (1.55–8.92) |
≥ 75 | 62 | 31 | 50.0 | 8.91 (4.01–19.78) | 5.23 (2.0–13.68) |
Hypertensiona | |||||
No | 127 | 29 | 22.8 | Reference | Reference |
Yes | 132 | 45 | 34.1 | 1.75 (1.01–3.03) | 0.71 (0.34–1.50) |
Dyslipidaemiaa | |||||
No | 180 | 42 | 23.3 | Reference | Reference |
Yes | 79 | 32 | 40.5 | 2.24 (1.27–3.94) | 1.45 (0.7–3.02) |
Smokingb | |||||
No | 202 | 66 | 32.7 | Reference | Reference |
Yes | 57 | 8 | 14.0 | 0.34 (0.15–0.75) | 0.33 (0.12–0.90) |
Antiarrhythmic drugs | |||||
No | 215 | 53 | 24.7 | Reference | Reference |
Yes | 44 | 21 | 47.7 | 2.79 (1.43–5.44) | 1.91 (0.81–4.48) |
LV hypertrophy | |||||
No | 89 | 18 | 20.2 | Reference | Reference |
Yes | 145 | 50 | 34.5 | 2.08 (1.02–3.86) | 1.86 (0.87–3.97) |
Valvular diseasec | |||||
No | 181 | 44 | 24.3 | Reference | Reference |
Yes | 77 | 30 | 39.0 | 1.99 (1.12–3.52) | 1.0 (0.50–2.01) |
Previous ischaemic lesions on neuroimaging | |||||
No | 155 | 36 | 23.2 | Reference | Reference |
Yes | 104 | 38 | 36.5 | 1.90 (1.10–3.29) | 1.47 (0.75–2.86) |
Stroke due to intracranial vessel occlusion | |||||
No | 209 | 53 | 25.4 | Reference | Reference |
Yes | 47 | 20 | 42.6 | 2.18 (1.13–4.21) | 1.71 (0.78–3.71) |
Score type | Sensitivity | Specificity | PPV | NPV | AF vs non-AF patients p value |
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AS5F ≥ 67.5 | 39.2 | 83.2 | 48.3 | 77.4 | < 0.001 |
Brown ESUS-AF ≥ 2 | 56.5 | 64.7 | 38.9 | 78.9 | 0.004 |
CHA2DS2-VASc ≥ 4 | 79.7 | 47.6 | 37.8 | 85.4 | < 0.001 |
CHASE-LESS ≥ 7 | 36.5 | 86.5 | 51.9 | 77.3 | < 0.001 |
HATCH ≥ 4 | 31.1 | 88.1 | 51.1 | 76.2 | < 0.001 |
HAVOC ≥ 4 | 52.8 | 71.3 | 42.2 | 79.1 | < 0.001 |
STAF ≥ 5 | 88.7 | 30.8 | 33.7 | 87.3 | 0.003 |
SURF > 700 | 92.2 | 42.7 | 41.8 | 92.4 | < 0.001 |