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

Background: CHADS-VASc score has been validated in risk prediction for stroke and thromboembolism in patients with atrial fibrillation (AF). Association of CHADS-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 CHADS-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 CHADS-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 CHADS-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 CHADS-VASc score (HR: 1.67, 95% CI: 1.19-2.16, P < .01) were found to be independently correlated with mortality. The patients whose CHADS-VASc score was between 1 and 3 had 5.67 times and patients whose CHADS-VASc score was ≥4 had 16.8 times higher risk of mortality compared to patients with CHADS-VASc score = 0.

Conclusion: Patients with higher CHADS-VASc scores had higher rates of mortality after APE.