Wengen Zhu1, Linghua Fu1, Ying Ding1, Lin Huang1, Zhenyan Xu1, Jinzhu Hu1, Kui Hong2. 1. Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China. 2. Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Key Laboratory of Molecular Medicine, Nanchang, Jiangxi 330006, China. Electronic address: hongkui88@163.com.
Abstract
BACKGROUND: Several studies have compared the discriminative performances of CHA2DS2-VASc and ATRIA scores, but the results are still disputed. Therefore, we aimed to explore their predictive abilities regarding stroke and thromboembolism (TE) risk in AF patients. METHODS: We systematically searched the Cochrane Library, PubMed and ScienceDirect databases up to May 2016 for studies regarding CHA2DS2-VASc and ATRIA scores. The data were extracted and then pooled using Review Manager software version 5.30. RESULTS: Six cohort studies with 363,432 participants were included. Using the published cut-off points, the pooled C-statistics were 0.66 for ATRIA and 0.63 for CHA2DS2-VASc (Pdiff>0.05). Using the optimized cut-off points, the C-statistics were 0.66 for ATRIA and 0.65 for CHA2DS2-VASc (Pdiff>0.05). However, the ATRIA score presented a positive net reclassification improvement (NRI) value compared with the CHA2DS2-VASc score. In contrast, the CHA2DS2-VASc score classified fewer patients as low and moderate risk than the ATRIA score. The CHA2DS2-VASc score had lower event rates (either events per person or events per 100 person-years) in both the low and moderate risk categories compared with the ATRIA score. CONCLUSIONS: In combination with C-statistics and NRI values, the ATRIA score performed better than the CHA2DS2-VASc score for stroke risk prediction. In contrast, the CHA2DS2-VASc score was superior to the ATRIA score for identifying truly "low risk" AF patients.
BACKGROUND: Several studies have compared the discriminative performances of CHA2DS2-VASc and ATRIA scores, but the results are still disputed. Therefore, we aimed to explore their predictive abilities regarding stroke and thromboembolism (TE) risk in AFpatients. METHODS: We systematically searched the Cochrane Library, PubMed and ScienceDirect databases up to May 2016 for studies regarding CHA2DS2-VASc and ATRIA scores. The data were extracted and then pooled using Review Manager software version 5.30. RESULTS: Six cohort studies with 363,432 participants were included. Using the published cut-off points, the pooled C-statistics were 0.66 for ATRIA and 0.63 for CHA2DS2-VASc (Pdiff>0.05). Using the optimized cut-off points, the C-statistics were 0.66 for ATRIA and 0.65 for CHA2DS2-VASc (Pdiff>0.05). However, the ATRIA score presented a positive net reclassification improvement (NRI) value compared with the CHA2DS2-VASc score. In contrast, the CHA2DS2-VASc score classified fewer patients as low and moderate risk than the ATRIA score. The CHA2DS2-VASc score had lower event rates (either events per person or events per 100 person-years) in both the low and moderate risk categories compared with the ATRIA score. CONCLUSIONS: In combination with C-statistics and NRI values, the ATRIA score performed better than the CHA2DS2-VASc score for stroke risk prediction. In contrast, the CHA2DS2-VASc score was superior to the ATRIA score for identifying truly "low risk" AFpatients.
Authors: Keith A A Fox; Saverio Virdone; Karen S Pieper; Jean-Pierre Bassand; A John Camm; David A Fitzmaurice; Samuel Z Goldhaber; Shinya Goto; Sylvia Haas; Gloria Kayani; Ali Oto; Frank Misselwitz; Jonathan P Piccini; Frederik Dalgaard; Alexander G G Turpie; Freek W A Verheugt; Ajay K Kakkar Journal: Eur Heart J Qual Care Clin Outcomes Date: 2022-03-02