The ABC-Death Score for Mortality Prediction in Patients With Atrial Fibrillation Undergoing Catheter Ablation

Yu-Feng Wang; Chao Jiang; Liu He; Xin Du; Xue-Yuan Guo; Ri-Bo Tang; Cai-Hua Sang; De-Yong Long; Jian-Zeng Dong; Gregory Y H Lip; Chang-Sheng Ma

doi:10.1016/j.jacasi.2023.07.007

The ABC-Death Score for Mortality Prediction in Patients With Atrial Fibrillation Undergoing Catheter Ablation

JACC Asia. 2023 Sep 26;3(5):790-801. doi: 10.1016/j.jacasi.2023.07.007. eCollection 2023 Oct.

Authors

Yu-Feng Wang¹, Chao Jiang¹, Liu He¹, Xin Du^{1

2

3}, Xue-Yuan Guo¹, Ri-Bo Tang¹, Cai-Hua Sang¹, De-Yong Long¹, Jian-Zeng Dong^{1

4}, Gregory Y H Lip⁵, Chang-Sheng Ma¹

Affiliations

¹ Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing, China.
² Heart Health Research Center, Beijing, China.
³ The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
⁴ Centre for Cardiovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Henan, China.
⁵ Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom.

Abstract

Background: Data on the performance of risk scores in predicting mortality risk after atrial fibrillation (AF) ablations are limited.

Objectives: The purpose of this study was to investigate the associations of mortality with preablation biomarkers and evaluate the performance of age, biomarker, and clinical history (ABC)-death score in patients with AF undergoing catheter ablation.

Methods: Patients with AF undergoing catheter ablations between 2013 and 2019 in the Chinese Atrial Fibrillation Registry were enrolled. Biomarkers associated with ABC-death score were quantified from baseline blood samples collected before AF ablation. Clinical outcomes were all-cause mortality and cardiac mortality. Discrimination, reclassification, clinical use, and calibration were further evaluated.

Results: We identified 4,218 patients with AF undergoing catheter ablations. During a median follow-up period of 4.0 years, 119 patients died due to all causes, with 49 dying due to cardiac causes. Biomarker levels were all independently associated with an increased risk of all-cause death and cardiac death. The ABC-death score was superior to the CHA₂DS₂-VASc score in predicting all-cause death (C index 0.73 vs 0.63; P = 0.001) and cardiac death (C index 0.83 vs 0.71; P = 0.007). Reclassification analysis revealed significant reclassification improvements of the ABC-death score compared with the CHA₂DS₂-VASc (cardiac failure or dysfunction, hypertension, age ≥75 [doubled], diabetes mellitus, stroke [doubled]-vascular disease, age 65 to 74 years and sex category [female]) score. Decision curve analysis showed the greater net benefit of use of the ABC-death score. Calibration plots presented an overestimation of the observed mortality event rate by ABC-death score.

Conclusions: Preablation biomarkers associated with ABC-death score were independently related to increased all-cause and cardiac mortality risk. Despite the overestimation of the event rate, the ABC-death score outperformed the CHA₂DS₂-VASc score in discriminating and reclassifying mortality risk, especially for cardiac mortality.

Keywords: ABC-death score; atrial fibrillation; biomarker; catheter ablation; mortality.