Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients With Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema
Authors: Paciaroni Maurizio , Agnelli Giancarlo , Caso Valeria , Tsivgoulis Georgios , Furie Karen L. , Tadi Prasanna , Becattini Cecilia , Falocci Nicola , Zedde Marialuisa , Abdul-Rahim Azmil H. , Lees Kennedy R. , Alberti Andrea , Venti Michele , Acciarresi Monica , D’Amore Cataldo , Mosconi Maria Giulia , Cimini Ludovica Anna , Procopio Antonio , Bovi Paolo , Carletti Monica , Rigatelli Alberto , Cappellari Manuel , Putaala Jukka , Tomppo Liisa , Tatlisumak Turgut , Bandini Fabio , Marcheselli Simona , Pezzini Alessandro , Poli Loris , Padovani Alessandro , Masotti Luca , Vannucchi Vieri , Sohn Sung-Il , Lorenzini Gianni , Tassi Rossana , Guideri Francesca , Acampa Maurizio , Martini Giuseppe , Ntaios George , Karagkiozi Efstathia , Athanasakis George , Makaritsis Kostantinos , Vadikolias Kostantinos , Liantinioti Chrysoula , Chondrogianni Maria , Mumoli Nicola , Consoli Domenico , Galati Franco , Sacco Simona , Carolei Antonio , Tiseo Cindy , Corea Francesco , Ageno Walter , Bellesini Marta , Colombo Giovanna , Silvestrelli Giorgio , Ciccone Alfonso , Scoditti Umberto , Denti Licia , Mancuso Michelangelo , Maccarrone Miriam , Orlandi Giovanni , Giannini Nicola , Gialdini Gino , Tassinari Tiziana , De Lodovici Maria Luisa , Bono Giorgio , Rueckert Christina , Baldi Antonio , D’Anna Sebastiano , Toni Danilo , Letteri Federica , Giuntini Martina , Lotti Enrico Maria , Flomin Yuriy , Pieroni Alessio , Kargiotis Odysseas , Karapanayiotides Theodore , Monaco Serena , Baronello Mario Maimone , Csiba Laszló , Szabó Lilla , Chiti Alberto , Giorli Elisa , Del Sette Massimo , Imberti Davide , Zabzuni Dorjan , Doronin Boris , Volodina Vera , Michel Patrik , Vanacker Peter , Barlinn Kristian , Pallesen Lars-Peder , Kepplinger Jessica , Bodechtel Ulf , Gerber Johannes , Deleu Dirk , Melikyan Gayane , Ibrahim Faisal , Akhtar Naveed , Gourbali Vanessa , Yaghi Shadi 
Published: February 2017

Background and Purposes—
This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation.

Methods—

The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00–1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08–2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39;
P
=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30–1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632–0.763;
P
=0.0001) for ischemic outcome events and 0.585 (0.493–0.678;
P
=0.10) for major bleedings.

Results—

The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529–0.763;
P
=0.009) for ischemic outcome events and 0.407 (0.275–0.540;
P
=0.14) for hemorrhagic outcome events.

Conclusions—
In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings.