Refining Residual Ischemic Stroke Risk in Anticoagulated Atrial Fibrillation Using Index Outpatient LA Diameter: The CHA2DS2-VALa Score.

The PAFIS score for risk stratification of atrial fibrillation detected after stroke: a multicenter cohort study

Background Atrial fibrillation detected after stroke (AFDAS) is clinically important, but AFDAS-specific risk tools for patients without known atrial fibrillation (AF) remain limited. We developed and temporally validated the Prediction of AF in Ischemic Stroke (PAFIS) score. Methods We retrospectively analyzed ischemic-stroke patients from the National Taiwan University Hospital Integrative Medical Data Center. The development cohort included patients hospitalized in 2010–2020 (n = 3406), and the temporal validation cohort included those hospitalized in 2021–2023 (n = 1366). Known AF (KAF) was defined as AF documented before stroke or within 14 days after stroke; AFDAS was defined as newly documented AF beyond 14 days among patients without KAF. Multivariable logistic regression restricted to KAF-free patients was used for score derivation. Discrimination, calibration, and time-to-AFDAS risk stratification were assessed. Results Among KAF-free patients, AFDAS was detected during routine clinical follow-up in 176 of 2175 (8.1%) in the development cohort and 148 of 1366 (10.8%) in the validation cohort. The final PAFIS score included age ≥ 75 years, female sex, valvular heart disease, left atrial diameter ≥ 40 mm, and tricuspid regurgitation peak gradient ≥30 mmHg. AUCs were 0.72 (95% CI, 0.68–0.76) in development and 0.65 (95% CI, 0.60–0.70) in validation. PAFIS outperformed CHA₂DS₂-VASc, HAVOC, and AF-ESUS, but not Brown ESUS-AF. Observed AFDAS detection rates increased across risk groups in both cohorts. Conclusions PAFIS provides a simple AFDAS-specific tool for selective post-stroke rhythm monitoring. Because AF ascertainment was based on routine clinical care without standardized prolonged monitoring, PAFIS predicts AF detection under routine practice rather than true AFDAS incidence. Prospective multicenter validation with standardized monitoring is warranted.

Analysis of accuracy of risk assessment tools for predicting new-onset atrial fibrillation in ST-elevation myocardial nfarction with percutaneous coronaty intervention (a systematic review)

The occurrence of NOAF was associated with increased in-hospital mortality, which was 2–3 times higher in patients with arrhythmia, and most NOAF prediction models developed specifically in STEMI cohorts undergoing PCI demonstrated higher discriminative ability.

Development and Validation of the GLORIA-AF Stroke Weighted Risk Score for Patients with Atrial Fibrillation.

BACKGROUND AND AIMS Accurate stroke-risk stratification is central to anticoagulation decision-making in patients with atrial fibrillation (AF), but conventional scores may not fully capture risk heterogeneity. We aimed to develop and externally validate an interpretable weighted score using a time-to-event framework. METHODS GLORIA-AF Phase II/III data were used to evaluate 17 baseline predictors using LASSO-penalized Cox regression with stability selection; coefficients were converted into integer weights. Performance was assessed using discrimination, calibration, integrated discrimination improvement (IDI), continuous net reclassification improvement (NRI), and decision-curve analysis. External validation was performed in EORP-AF and APHRS-AF registries. RESULTS Among 20,517 patients included in the derivation cohort (mean [SD] age, 69.9 [10.3] years; 9,196 women [44.8%]), 487 (2.4%) had stroke, and 17,397 (84.8%) were receiving anticoagulation at baseline. Ten selected predictors formed a 0-23-point score. The derived score achieved a C-index of 0.661 (95% CI, 0.636-0.685), higher than CHA2DS2-VA (0.626; P < 0.001), CHA2DS2-VASc (0.615; P < 0.001), and the unweighted score (P = 0.016), with no significant difference from the full Cox or machine learning models. In external validation (8,309 patients; 147 strokes), the C-index was 0.652 (95% CI, 0.614-0.690) versus 0.616 for CHA2DS2-VA (95%CI, 0.598-0.634; P < 0.001). IDI/NRI, calibration, and decision-curve analyses supported improved risk differentiation, close calibration, and generally greater net benefit than CHA2DS2-VA. The score retained higher discrimination than CHA2DS2-VA among patients without baseline anticoagulation (P < 0.001). CONCLUSION The GLORIA-AF Stroke Weighted Risk Score provides risk refinement beyond CHA2DS2-VA while retaining discrimination consistent with more complex models. External validation supports its transportability and potential adjunctive role in guideline-directed thromboembolic risk assessment.

Artificial intelligence shows comparable or improved performance to traditional risk models in predicting atrial fibrillation after cryptogenic stroke

In patients with cryptogenic stroke receiving an ICM, the ECG-AI score showed modest discrimination for AF detection, outperforming CHA2DS2-VA and HAVOC, but not Brown ESUS-AF, which indicates a possible role for AI-driven ECG analysis in risk stratification.

Predictive value of acute atrial fibrillation for short-term mortality after ischemic stroke

Background Atrial fibrillation (AF) is an important risk factor for ischemic stroke. However, the prognostic impact of acute atrial fibrillation (AAF) at the onset of acute ischemic stroke (AIS) remains unclear. Methods This retrospective study categorized 417 patients with AIS into the AAF (n = 72), other AF (n = 142), and non-AF (n = 203) groups. Multivariate logistic regression analysis of associations with 30-day all-cause mortality and severe early neurological deficit (7-day NIHSS ≥16). Results The AAF group demonstrated significantly worse outcomes than the other AF and non-AF groups. In the multivariable analysis, AAF was identified as an independent risk predictor for severe 7-day neurological deficit [odds ratio (OR): 10.09; 95% CI: 3.87−27.36; P < 0.001] and all-cause mortality within 30 days (OR: 4.11; 95% CI: 2.28−7.43; P < 0.001). Conclusions AAF at the onset of AIS is an independent risk predictor for early neurological deterioration and short-term mortality, establishing it as a crucial prognostic indicator that warrants vigilant management.

Left Ventricular Fibrosis on T1 Mapping is Associated with Increased Risk of Incident Atrial Fibrillation: Results from the Multi-Ethnic Study of Atherosclerosis (MESA).