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. 2024 Dec 29;15(1):e70032.
doi: 10.1002/pul2.70032. eCollection 2025 Jan.

Performance of Risk-Stratification Scores for Patients With Pulmonary Arterial Hypertension in a Multi-Ethnic Asian Population

Haowen Jiang  1 , Ju Le Tan  1   2 , Wen Ruan  1 , Jin Shing Hon  1 , Aidila Ismail  1 , Chee Lan Lim  1 , Sumathy Perumal  1 , Michelle Koh  3 , Duu Wen Sewa  3 , Ghee Chee Phua  3 , Ying Zi Oh  4 , Sue-Ann Ng  5 , Cassandra Hong  5 , Andrea Low  5 , Soo Teik Lim  1   2 , Jonathan Yap  1   2
Affiliations

Performance of Risk-Stratification Scores for Patients With Pulmonary Arterial Hypertension in a Multi-Ethnic Asian Population

Haowen Jiang et al. Pulm Circ. .

Abstract

Guidelines recommend risk stratification of pulmonary arterial hypertension (PAH) patients to guide management. There are currently several risk stratification scores available, which have largely been validated in various pulmonary hypertension registries in the West but not in Asia. We aim to study the performance of these different risk scores in PAH patients from a multi-ethnic Asian population. A retrospective review of all PAH patients from Jan 2014 to Jun 2021 from a tertiary cardiac center was performed. Mortality outcomes were obtained from national registries. Using the 2022 ESC/ERS, REVEAL Lite 2.0 and COMPERA 2.0 risk scores, patients were classified into different risk strata at baseline and at follow-up and changes in any risk strata recorded. The prognosis of patients based on these factors was compared. A total of 153 patients (mean age: 57 ± 17 years; 117 women; 94 Chinese, 33 Malay, 19 Indian) were included. All three scores showed significant difference in mortality outcomes between the different risk strata both at baseline and at follow-up (p < 0.05), with the highest risk group showing the highest mortality. Patients who worsened to or remained at intermediate/high-risk generally had a worse prognosis than those who remained stable at or improved to low-risk strata. The 2022 ESC/ERS and COMPERA 2.0 risk scores had C-statistics of 0.73 (0.58-0.88) and 0.80 (0.72-0.88), respectively, for predicting 1-year mortality. Serial risk stratification is a useful tool in prognosticating Asian PAH patients and may play an important role in guiding therapeutic management.

Keywords: primary pulmonary hypertension; pulmonary arterial hypertension; pulmonary circulation and pulmonary hypertension; risk stratification.

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Conflict of interest statement

JY received speaker's honorarium from Abbott, Biosensors, Biotronik, Boston Scientific, Edwards, GE healthcare, J&J, Kaneka, Medtronic and Terumo. AL received consultancy fees and is on the advisory boards of Janssen and Boehringer‐Ingelheim, and is on the steering committee and received research grants from Boehringer‐Ingelheim. All other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Cox survival curves* by baseline risk strata using (A) 2022 ESC/ERS guidelines, (B) COMPERA 2.0 score, and (C) REVEAL Lite 2.0 score. *Adjusted for age, gender, and pulmonary arterial hypertension subtype.
Figure 2
Figure 2
Adjusted hazards ratios* at baseline for each risk strata using (A) 2022 ESC/ERS guidelines, (B) COMPERA 2.0 score, and (C) REVEAL Lite 2.0 score. *Adjusted for age, gender, and pulmonary arterial hypertension subtype.
Figure 3
Figure 3
Sankey diagrams showing changes in risk strata using (A) 2022 ESC/ERS guidelines, (B) COMPERA 2.0 score, and (C) REVEAL Lite 2.0 score.
Figure 4
Figure 4
Cox survival curves* by changes in risk strata using (A) 2022 ESC/ERS guidelines, (B) COMPERA 2.0 score, and (C) REVEAL Lite 2.0 score. *Adjusted for age, gender, and pulmonary arterial hypertension subtype.
Figure 5
Figure 5
Adjusted hazards ratios* for changes in risk strata using (A) 2022 ESC/ERS guidelines, (B) COMPERA 2.0 score, and (C) REVEAL Lite 2.0 score. *Adjusted for age, gender, and pulmonary arterial hypertension subtype.
Figure 6
Figure 6
Receiver Operating Curve for 1‐year mortality at (A) baseline and (B) follow‐up.
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