Higher CHA₂DS₂-VASc Score Is Associated With Increased Mortality in Acute Pulmonary Embolism

Abstract

Background: CHA 2 DS 2 -VASc score has been validated in risk prediction for stroke and thromboembolism in patients with atrial fibrillation (AF). Association of CHA 2 DS 2 -VASc score with higher risk of venous thromboembolism and pulmonary embolism (PE) has also been shown. In this study, we investigated the long-term prognostic value of CHA 2 DS 2 -VASc score in patients with acute pulmonary embolism (APE). Methods: Consecutive patients with APE presenting to our emergency department were retrospectively recruited. Patients with AF and who died secondary to causes other than PE were excluded from the study. The CHA 2 DS 2 -VASc score and pulmonary embolism severity index (PESI) were calculated. Results: Two hundred seventy seven participants were included in the study. The mortality rate was 18.7%. Twenty-two cases died within 30 days, and 30 cases died during the follow-up period (median: 13 months). The mean CHA 2 DS 2 -VASc score was significantly higher in dead patients compared to survivors (3.61 + 1.35 vs 1.95 + 1.52, P < .01). In multivariate regression analysis, systolic pulmonary artery pressure (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 1.01-1.06, P ¼ .02), PESI score (HR: 1.010, 95% CI: 1.004-1.017, P < .01), and CHA 2 DS 2 -VASc score (HR: 1.67, 95% CI: 1.19-2.16, P < .01) were found to be independently correlated with mortality. The patients whose CHA 2 DS 2 -VASc score was between 1 and 3 had 5.67 times and patients whose CHA 2 DS 2 -VASc score was 4 had 16.8 times higher risk of mortality compared to patients with CHA 2 DS 2 -VASc score ¼ 0. Conclusion: Patients with higher CHA 2 DS 2 -VASc scores had higher rates of mortality after APE.

Coronary artery calcification is associated with mortality independent of pulmonary embolism severity: a retrospective cohort study

“…3,29,30 Furthermore, in a cohort of patients investigated for suspected PE, those in whom PE was excluded had a 6-month mortality, which was higher than those with proven PE 31 ; however, in the Multi-Ethnic Study of Atherosclerosis a high CACS was not associated with an increased risk of PE. 10 A prior history of cardiovascular disease 32 and a higher CHA2DS2-VASc score 33 have been shown to be associated with increased mortality in patients with acute PE. The presence of known coronary artery disease was associated with a 2.2-fold increase in allcause mortality at nearly 4 years of follow-up in a cohort study of 1,023 patients admitted with confirmed PE.…”

Relationship Between CHA2DS2-VASc Score and Right Ventricular Dysfunction in Patients With Acute Pulmonary Thromboembolism

“…Therefore, the score was matched against the outcomes of several diseases such as atrial fibrillation with pulmonary embolism, chronic obstructive pulmonary disease with or without AF, decreased left ventricular ejection fraction, and coronary artery disease. 12,21-25 In this study, we firstly investigated the association of the CHA2DS2-VASc score with the RVD, clinical subgroups, and in-hospital mortality. In addition to the abovementioned studies, in this study, we found that the CHA2DS2-VASc score was significantly different among the clinical subgroups in patients with acute PTE and determined that the CHA2DS2-VASc score was an independent predictor of the RVD in these patients.…”

Does CHA2DS2-VASc score predict mortality in chronic kidney disease?

“…In terms of predicting all-cause mortality in systolic HF patients, R2CHADS2 seems to be the best of the three scoring systems, especially in systolic HF patients without AF [ 25 ]. Moreover, CHA2DS2-VASC score highly predicts all-cause mortality in patients’ acute ischemic stroke [ 26 ], ICD [ 27 ], and acute pulmonary embolism [ 28 ]. CHADS2, CHA2DS2-VASc and CHA2DS2-VASc-M (modified version of the CHA2DS2-VASc scoring system in which 1 point was assigned to male instead of female sex) have also been significantly associated with all-cause mortality in COVID-19 patients [ 29 ].…”