5770A novel biomarker-based risk score to predict death in patients with atrial fibrillation: Insights from the ARISTOTLE and RE-LY trials

Abstract

Background: Biomarker-based ABC risk scores for stroke and bleeding in atrial fibrillation (AF) have been published. However, there are no established risk scores at present for death, which is the most common outcome event in anticoagulated patients with AF. Purpose: To develop and validate a new biomarker-based risk score to improve the prognostication of death in anticoagulated patients with AF. Methods: A new risk score was developed and internally validated in 14,611 patients with AF from the ARISTOTLE trial with biomarkers levels determined at baseline using high-sensitivity assays. The median follow-up was 1.9 years. Biomarkers and clinical variables significantly predicting all-cause mortality were assessed by Cox-regression and each variable obtained a weight proportional to the model coefficients. External validation was performed in 8,548 patients with AF from the RE-LY trial with a median follow-up of 2.1 years. Results: 1047 patients died during follow-up in the derivation cohort. The most important predictors of death were NT-proBNP, cardiac troponin T (cTnT), growth differentiation factor-15 (GDF-15), older age, and heart failure. These variables were therefore included in the ABC (Age, Biomarkers, Clinical history) death risk score. The ABC-death score was well-calibrated (Figure) and yielded a higher cindex than the CHA2DS2-VASc score in both the derivation cohort (0.74 vs. 0.59, p<0.001) and the external validation cohort (0.74 vs. 0.58, p<0.001). The ABCdeath risk score performed consistently in several clinically important subgroups. Conclusions: A new biomarker-based risk score for predicting risk of death in patients with AF was successfully developed and validated in large independent AF cohorts on oral anticoagulation. The ABC-death risk score performed well and may help physicians in the decision-making when treating patients with AF. As the ABC-death score is based on the same biomarkers as the ABC-stroke and ABCbleeding scores it may be easily implemented in clinical practice allowing the full assessment of the different spectrum of risks in patients with AF. (Figure Presented).