Abstract: Objective The clinical application of two adult pulmonary hypertension risk stratification scales recommended by Chinese Guidelines for Diagnosis and Treatment of Pulmonary Hypertension (2018 and 2021 Editions) in the real world. Methods Clinical data were collected from 127 pulmonary arterial hypertension patients who were admitted in the Affiliated Hospital of Xuzhou Medical University and the First Affiliated Hospital of Chongqing Medical University from January 2016 to February 2021. The risk stratification and prognosis of the patients were compared using the risk stratification scales recommended by the two guidelines mentioned above. Results A total of 127 patients were enrolled, including 21 men (16.5%) and 106 women (83.5%), with a median age of 38.0 (27.5, 51.0) years. There was no statistical difference in WHO cardiac function classification, echocardiographic indexes, brain natriuretic peptide, and hemodynamic indexes among the low, middle, and high risk groups of 2018 and 2021 Editions. There was no difference in the distribution of the number of cases according to different risk stratification scales. The follow-up period was until March 30, 2022, and the median follow-up time was 30.6 months. The survival curve showed that the 1-year survival rates of the low, medium, and high risk groups in both 2018 and 2021 Editions were consistent with the predicted risk of death. According to the risk stratification scale (2018 Edition), there was no statistical difference in 5-year survival rate among the low, medium, and high risk groups (P>0.05). According to the risk stratification scale (2021 Edition), statistical difference was found in 5-year survival rate among the low, middle and high risk groups (P<0.05). Conclusions The predictive value of the risk stratification scales (2018 and 2021 Editions) for 1-year mortality in patients with pulmonary arterial hypertension was consistent. According to the risk stratification scale (2021 Edition), The 5-year survival curves of the low, medium and high risk patients were consistent with the predicted results of risk stratification.