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. 2013 Sep;10(3):258-66.
doi: 10.3969/j.issn.1671-5411.2013.03.004.

CHADS2 versus CHA2DS2-VASc score in assessing the stroke and thromboembolism risk stratification in patients with atrial fibrillation: a systematic review and meta-analysis

Jia-Yuan Chen  1 , Ai-Dong Zhang, Hong-Yan Lu, Jun Guo, Fei-Fei Wang, Zi-Cheng Li
Affiliations

CHADS2 versus CHA2DS2-VASc score in assessing the stroke and thromboembolism risk stratification in patients with atrial fibrillation: a systematic review and meta-analysis

Jia-Yuan Chen et al. J Geriatr Cardiol. 2013 Sep.

Abstract

Objective: To perform a systematic review and meta-analysis of the predictive abilities of CHADS2 and CHA2DS2-VASc in stroke and thromboembolism risk stratification of atrial fibrillation (AF) patients.

Methods: We searched PubMed and EMBASE for English-language literature on comparisons of the diagnostic performance between CHADS2 and CHA2DS2-VASc in predicting stroke, or systemic embolism, in AF. We then assessed the quality of the included studies and pooled the C-statistics and 95% confidence intervals (95% CI).

Results: Eight studies were included. It was unsuitable to perform a direct meta-analysis because of high heterogeneity. When analyzed as a continuous variable, the C-statistic ranged from 0.60 to 0.80 (median 0.683) for CHADS2 and 0.64-0.79 (median 0.673) for CHA2DS2-VASc. When analyzed as a continuous variable in anticoagulation patients, the subgroup analysis showed that the pooled C-statistic (95% CI) was 0.660 (0.655-0.665) for CHADS2 and 0.667 (0.651-0.683) for CHA2DS2-VASc (no significant difference). For non-anticoagulation patients, the pooled C-statistic (95% CI) was 0.685 (0.666-0.705) for CHADS2 and 0.675 (0.656-0.694) for CHA2DS2-VASc (no significant difference). The average ratio of endpoint events in the low-risk group of CHA2DS2-VASc was less than CHADS2 (0.41% vs. 0.94%, P < 0.05). The average proportion of the moderate-risk group of CHA2DS2-VASc was lower than CHADS2 (11.12% vs. 30.75%, P < 0.05).

Conclusions: The C-statistic suggests a similar clinical utility of the CHADS2 and CHA2DS2-VASc scores in predicting stroke and thromboembolism, but CHA2DS2- VASc has the important advantage of identifying extremely low-risk patients with atrial fibrillation, as well as classifying a lower proportion of patients as moderate risk.

Keywords: Atrial fibrillation; CHA2DS2-VASc; CHADS2; Meta-analysis; Prediction; Stroke.

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Figures

Figure 1.
Figure 1.. Overview of the research strategy.
Figure 2.
Figure 2.. Meta-analysis of the C-statistic of CHADS2 anticoagulation patients when analysed as a continuous variable.
Figure 3.
Figure 3.. Meta-analysis of the C-statistic of CHA2DS2-VASc anticoagulation patients when analysed as a continuous variable.
Figure 4.
Figure 4.. Meta-analysis of the C-statistic of CHADS2 non-anticoagulation patients when analysed as a continuous variable.
Figure 5.
Figure 5.. Meta-analysis of the C-statistic of CHA2DS2-VASc non-anticoagulation patients when analysed as a continuous variable.
See this image and copyright information in PMC

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