Ischemic stroke prediction model of sick sinus syndrome patients without atrial fibrillation: insights from atrial myopathy

Sick Sinus Syndrome (SSS) has been identified as a risk factor for ischemic stroke. Thrombus assessment in SSS patients without atrial fibrillation (AF) or atrial flutter (AFL) remains underexplored. We aims to develop a predictive model for ischemic stroke risk specifically in SSS patients without AF/AFL. Patients diagnosed with SSS and without AF/AFL were consecutively enrolled from single center. Incident AF/AFL cases were excluded during follow-up period. Symptomatic ischemic stroke was confirmed by reviewing the all available medical records. After a median follow-up of 1215 days, 187 out of 1645 (11.9%) patients experienced symptomatic ischemic stroke. Key predictors identified via multivariable Cox regression included age, left atrial diameter (LAD), prolonged P-wave duration (PWD), neutrophil-lymphocyte ratio (NLR), non-AF atrial tachyarrhythmias, and prior thrombotic events. These variables were incorporated into our nomogram prediction model, which demonstrated superior calibration and performance compared to the CHA2DS2-VASc score. The incidence of new-onset ischemic stroke in SSS patients is notably high, warranting focused attention in clinical practice. We developed the model evaluate the risk for ischemic stroke of SSS patients without AF/AFL and internally validated. This risk score performs better than CHA2DS2-VASC score and may providing evidence of thrombus assessment in patients with atrial myopathy.