Background: Several studies have compared the discriminative performances of CHADS-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 CHADS-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 CHADS-VASc (P>0.05). Using the optimized cut-off points, the C-statistics were 0.66 for ATRIA and 0.65 for CHADS-VASc (P>0.05). However, the ATRIA score presented a positive net reclassification improvement (NRI) value compared with the CHADS-VASc score. In contrast, the CHADS-VASc score classified fewer patients as low and moderate risk than the ATRIA score. The CHADS-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 CHADS-VASc score for stroke risk prediction. In contrast, the CHADS-VASc score was superior to the ATRIA score for identifying truly "low risk" AF patients.
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