Improvement in risk prediction for patients with atrial fibrillation and intermediate-risk CHA2DS2-VASc score utilizing highly sensitive cardiac troponin T
Background Guidelines of the European Society of Cardiology recommend a clinical risk assessment for patients with atrial fibrillation (AF). However, scores such as the CHA2DS2-VASc score show only a modest performance for prediction of adverse endpoints. Methods This retrospective single-center all...
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| Hauptverfasser: | , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
August 21, 2025
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| In: |
PLOS ONE
Year: 2025, Jahrgang: 20, Heft: 8, Pages: 1-14 |
| ISSN: | 1932-6203 |
| DOI: | 10.1371/journal.pone.0330164 |
| Online-Zugang: | Verlag, kostenfrei, Volltext: https://doi.org/10.1371/journal.pone.0330164 Verlag, kostenfrei, Volltext: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0330164 
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| Verfasserangaben: | Christian Salbach, Mustafa Yildirim, Barbara Ruth Milles, Hauke Hund, Matthias Mueller-Hennessen, Norbert Frey, Hugo Katus, Evangelos Giannitsis |
| Zusammenfassung: | Background Guidelines of the European Society of Cardiology recommend a clinical risk assessment for patients with atrial fibrillation (AF). However, scores such as the CHA2DS2-VASc score show only a modest performance for prediction of adverse endpoints. Methods This retrospective single-center all-comer study uses data from the Heidelberg Registry of Atrial Fibrillation of 9,995 patients with non-valvular AF presenting to the emergency department (ED) of the University Hospital of Heidelberg from June 2009 until March 2020. Per CHA2DS2-VASc, risk was classified as low (0 point in men, ≤ 1 point in females), intermediate, or high (≥2 points in men and ≥3 points in females). The predictive performance of the CHA2DS2-VASc score, with and without highly sensitive cardiac troponin T (hs-cTnT), was evaluated for a composite endpoint comprising stroke, myocardial infarction (MI) or all-cause mortality. Results Performance of the CHA2DS2-VASc score for the prediction of the composite endpoint was poor Area under the curve (AUC): 0.648 (95%CI: 0.638-0.657) particularly in patients at intermediate-risk AUC: 0.542 (95%CI: 0.508-0.575). Adding hs-cTnT improved discrimination substantially in intermediate-risk patients (AUC: 0.778, 95% CI: 0.748-0.805). Notably, no events occurred in intermediate-risk patients with undetectable hs-cTnT (<5 ng/L). Conclusion In patients with AF at intermediate thromboembolic risk, the addition of hs-cTnT to the CHA₂DS₂-VASc score enhances prediction of adverse cardiovascular outcomes. Hs-cTnT may help identify patients who could benefit from anticoagulation, while also identifying a low-risk subgroup unlikely to experience events. |
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| Beschreibung: | Gesehen am 30.01.2026 Im Titel ist "2" tiefgestellt |
| Beschreibung: | Online Resource |
| ISSN: | 1932-6203 |
| DOI: | 10.1371/journal.pone.0330164 |