Stratifying Stroke Risk in Atrial Fibrillation: Beyond Clinical Risk Scores

Shadi Yaghi, MD; Hooman Kamel, MD


Stroke. 2017;48(10):2665-2670. 

In This Article

Prediction of Stroke Recurrence

Stroke recurrence is an independent predictor of in-hospital mortality in patients with cardioembolic stroke. Although clinical scores have fair-to-good ability to predict long-term stroke risk in patients with AF, there are limited data on predictors of early stroke recurrence.[72] Recently, a multicenter prospective study found that predictors of early stroke recurrence in patients with AF included severe LA enlargement (HR, 2.05; 95% CI, 1.08–2.87), brain infarct size >1.5 cm (HR, 1.82; 95% CI, 1.00–3.33), and advanced age (HR per year, 1.06; 95% CI, 1.00–1.11).[73] Based on this cohort, the ALESSA score (age ≥80 years, 2 points; between 70 and 79 years, 1 point; ischemic lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point) was derived and validated in a separate patient cohort.[73] Higher ALESSA scores were shown to predict recurrent ischemic events at 90 days in both the derivation (C statistic, 0.7) and validation (C statistic, 0.65) cohorts. The ALESSA score was less predictive of the risk of hemorrhagic complications in the derivation (C statistic, 0.59) and validation (C statistic, 0.41) cohorts.[73]