The Present and Future
JACC Review Topic of the Week
Ischemic Stroke Risk in Patients With Nonvalvular Atrial Fibrillation: JACC Review Topic of the Week

https://doi.org/10.1016/j.jacc.2019.10.040Get rights and content
Under an Elsevier user license
open archive

Highlights

  • Ischemic stroke risk prediction is a cornerstone in the management of patients with atrial fibrillation.

  • The paper reviews the evolution of these risk scores, discusses their strengths and limitations, and appraises the emerging risk assessment tools and their incremental utility.

  • There is an unmet need for a comprehensive study incorporating various clinical, anatomic, and biophysiological risk factors to optimize our stroke prevention practices in patients with atrial fibrillation.

Abstract

The last decade has witnessed remarkable advances in pharmacological and nonpharmacological strategies for stroke prevention in patients with atrial fibrillation. However, the currently available clinical stroke risk prediction models do not account for key nonclinical factors (arrhythmia burden, left atrial physiology and anatomy, chemical and electrocardiographic markers) and other competing clinical risks. Hence, their ability to identify patients who will derive the most benefit from pharmacological and mechanical risk prevention strategies remain limited. In this paper, the authors review the current and evolving ischemic stroke risk prediction schemes in patients with nonvalvular atrial fibrillation, highlight the strengths and weaknesses of the models, and discuss the unmet needs in this field.

Key Words

atrial fibrillation
oral anticoagulation
risk assessment
stroke

Abbreviations and Acronyms

AF
atrial fibrillation
AI
artificial intelligence
CI
confidence interval
HR
hazard ratio
LA
left atrium
LAA
left atrial appendage
LAAO
left atrial appendage occlusion
NT-proBNP
N-terminal pro–B-type natriuretic peptide
NVAF
nonvalvular atrial fibrillation
OAC
oral anticoagulation
RCT
randomized clinical trial
RR
relative risk
SE
systemic embolization

Cited by (0)

Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.