Evaluation of the ATRIA and CHA2DS2-VASc Scores and Their Performance on Predicting Mortality in Patients with Acute Pulmonary Embolism

Abstract

Aim: Pulmonary embolism (PE) is a condition caused by thrombosis and is a common cause of death. Although there are studies of PE with CHA2DS2-VASc (C: congestive heart failure or left ventricular systolic dysfunction, H: hypertension, A: age of ≥ 75 years, D: diabetes mellitus, S: previous stroke, V: vascular disease, A: age between 65 and 74 years, Sc: female gender) and PE severity index (PESI) scores, there is no data on Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) score in PE or comparison of CHA2DS2-VASc and ATRIA scores in PE. We investigated whether ATRIA and CHA2DS2-VASc scores can predict PE and mortality in cases of PE. Methods: One hundred ninety-eight patients with PE and two hundred eighty controls between July 2017 and July 2021 were included in this retrospective study. Patients’ data was provided from the hospital’s digital system. Patients’ PESI, ATRIA, and CHA2DS2-VASc scores were calculated, and in-hospital mortality was determined as the primary end-point. Results: The mean age of the patients was 63.9±13.1 years. The frequency of male patients in the PE group was higher (p=0.04), but this difference was invalid in patients with PE who developed primary end-point (p=0.177). ATRIA and CHA2DS2-VASc scores were higher in the PE group (p<0.01 and p=0.02, respectively) and in patients who reached end-point (p=0.001 and p=0.004, respectively). A moderate-high correlation was found between the PESI score and the ATRIA and CHA2DS2-VASc scores (r=0.664, p<0.001, and r=0.484, p<0.001) in the PE group. Pairwise comparison of ROC curve analysis revealed that PESI, ATRIA, and CHA2DS2-VASc scores were not superior to each other in predicting mortality. Conclusion: Both ATRIA and CHA2DS2-VASc scores are simple, easily calculated risk scores as an alternative to the PESI score in predicting mortality in PE.