ESOC 2025 | The need for improved risk prediction scores to identify recurrence after AF-related stroke
John McCabe, MB, BCh, BAO, MRCPI, PhD, Mater Misericordiae University Hospital, Dublin, Ireland, emphasizes the need for new risk prediction scores to identify patients at a higher risk of recurrence after an atrial fibrillation (AF)-related stroke. He suggests collaborative international efforts to develop new risk prediction scores, which could be used to select patients for more invasive intervention strategies, such as left atrial appendage occlusion devices. This interview took place at the 11th European Stroke Organisation Conference (ESOC) in Helsinki, Finland.
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Transcript
I think when we consider the high residual risk of recurrence in patients with AF-related stroke, these data would strongly argue that we urgently need new risk prediction scores to identify patients at higher risk. And secondly, we need to start thinking about utilising new interventions that may mitigate this risk. In terms of risk prediction scores, the established risk prediction score conventionally used to identify patients at high stroke risk with atrial fibrillation is the CHA2DS2-VASc score...
I think when we consider the high residual risk of recurrence in patients with AF-related stroke, these data would strongly argue that we urgently need new risk prediction scores to identify patients at higher risk. And secondly, we need to start thinking about utilising new interventions that may mitigate this risk. In terms of risk prediction scores, the established risk prediction score conventionally used to identify patients at high stroke risk with atrial fibrillation is the CHA2DS2-VASc score. However, the score appears to be suboptimal in patients with ischemic stroke. And so I would like to see collaborative efforts internationally to try and develop new risk prediction scores for patients with AF-related stroke. And if we can use these scores with high accuracy to identify those with greatest risk, we may then start being able to select these patients for more invasive intervention strategies. And we’re lucky in that there are opportunities in this field. We know that left atrial appendage occlusion devices are probably non-inferior to oral anticoagulation in preventing AF-related stroke, but also data from the LAAOS 3 trial has shown that the addition of oral anticoagulation to, sorry, the addition of left atrial appendage occlusion to oral anticoagulation has an additional benefit of lowering one’s ischemic stroke risk. And perhaps in the future, if we have patients who are at greater risk of future recurrent stroke, we may think about administering not just oral anticoagulation, but also performing a percutaneous left atrial appendage occlusion to reduce this residual risk. Of course, we would need to demonstrate that this intervention was effective in randomized control trials after ischemic stroke. And we would also want to demonstrate that this procedure can be done safely as well. However, I do think that in addition to left atrial appendage occlusion devices, other interventions such as rhythm control may be useful in reducing the high residual risk after AF-related stroke.
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