Meta-analysis of ATRIA versus CHA₂DS₂-VASc for predicting stroke and thromboembolism in patients with atrial fibrillation

Background: Several studies have compared the discriminative performances of CHA₂DS₂-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 CHA₂DS₂-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 CHA₂DS₂-VASc (P_diff>0.05). Using the optimized cut-off points, the C-statistics were 0.66 for ATRIA and 0.65 for CHA₂DS₂-VASc (P_diff>0.05). However, the ATRIA score presented a positive net reclassification improvement (NRI) value compared with the CHA₂DS₂-VASc score. In contrast, the CHA₂DS₂-VASc score classified fewer patients as low and moderate risk than the ATRIA score. The CHA₂DS₂-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 CHA₂DS₂-VASc score for stroke risk prediction. In contrast, the CHA₂DS₂-VASc score was superior to the ATRIA score for identifying truly "low risk" AF patients.