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Higher CHA2DS2-VASc Score Is Associated With Increased Mortality in Acute Pulmonary Embolism
Tolga Onuk1, Mehmet Baran Karataş1, Göktürk İpek1
11 Department of Cardiology, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Hospital, Istanbul, Turkey.
Insights
The CHA2DS2-VASc score, used for atrial fibrillation patients, predicts mortality in acute pulmonary embolism (APE) patients. Higher scores indicate a significantly increased risk of death following APE.
Area of Science:
- Cardiology
- Pulmonology
- Thromboembolic Disease
Background:
- CHA2DS2-VASc score is validated for stroke risk in atrial fibrillation (AF).
- Its association with venous thromboembolism and pulmonary embolism (PE) risk is established.
- This study assesses the prognostic value of CHA2DS2-VASc in acute pulmonary embolism (APE).
Purpose of the Study:
- To investigate the long-term prognostic value of the CHA2DS2-VASc score in patients diagnosed with acute pulmonary embolism (APE).
Main Methods:
- Retrospective analysis of consecutive APE patients presenting to the emergency department.
- Exclusion of patients with AF or non-PE related mortality.
- Calculation of CHA2DS2-VASc and pulmonary embolism severity index (PESI) scores.
Main Results:
- The study included 277 participants with an overall mortality rate of 18.7%.
- Mean CHA2DS2-VASc score was significantly higher in non-survivors (3.61) versus survivors (1.95).
- CHA2DS2-VASc score independently predicted mortality (HR: 1.67), with scores ≥4 associated with a 16.8-fold increased mortality risk.
Conclusions:
- Higher CHA2DS2-VASc scores are correlated with increased mortality rates in patients following acute pulmonary embolism.
- The CHA2DS2-VASc score serves as a valuable prognostic tool for APE patients.
Background:
CHA2DS2-VASc score has been validated in risk prediction for stroke and thromboembolism in patients with atrial fibrillation (AF). Association of CHA2DS2-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 CHA2DS2-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 CHA2DS2-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 CHA2DS2-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 = .02), PESI score (HR: 1.010, 95% CI: 1.004-1.017, P < .01), and CHA2DS2-VASc score (HR: 1.67, 95% CI: 1.19-2.16, P < .01) were found to be independently correlated with mortality. The patients whose CHA2DS2-VASc score was between 1 and 3 had 5.67 times and patients whose CHA2DS2-VASc score was ≥4 had 16.8 times higher risk of mortality compared to patients with CHA2DS2-VASc score = 0.
Conclusion:
Patients with higher CHA2DS2-VASc scores had higher rates of mortality after APE.
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