Related Experiment Video
Updated: Nov 23, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Impact of Combined "CHADS-BLED" Score to Predict Short-Term Outcomes in Transfemoral and Transapical Aortic Valve
Verena Veulemans1, Oliver Maier1, Georg Bosbach1
1Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, Düsseldorf 40225, Germany.
Insights
The CHADS-BLED score effectively predicts 30-day mortality in transcatheter aortic valve replacement (TAVR) patients with atrial fibrillation (AF). High CHADS-BLED scores also indicate increased risks of major vascular events and cerebrovascular insults in TAVR patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Risk Stratification
Background:
- High CHA2DS2-VASC and HAS-BLED scores correlate with increased mortality in cardiovascular interventions.
- These scores' predictive value in transcatheter aortic valve replacement (TAVR) across different access routes needs further investigation.
- Quantifying risks for 30-day mortality, major vascular/bleeding events (MVASC/BARC), and cerebrovascular insults (CVI) in TAVR is crucial.
Purpose of the Study:
- To assess the predictive capability of CHA2DS2-VASC, HAS-BLED, and a combined CHADS-BLED score for TAVR outcomes.
- To compare these scores against established EuroSCORE and STS scores.
- To evaluate risks stratified by transfemoral (TF) versus transapical (TA) TAVR access routes.
Main Methods:
- Analysis of 1329 TAVR patients: 980 TF-TAVR and 349 TA-TAVR.
- Calculation and comparison of CHA2DS2-VASC, HAS-BLED, and CHADS-BLED scores.
- Evaluation of predictive accuracy (c-index) for 30-day mortality, MVASC/BARC, and CVI.
Main Results:
- The CHADS-BLED score strongly predicted 30-day mortality in TF-TAVR patients with atrial fibrillation (AF) (c-index: 0.83).
- STS score predicted mortality in TF-TAVR (c-index: 0.68), and EuroSCORE in TA-TAVR (c-index: 0.66).
- High CHADS-BLED was associated with increased CVI and MVASC/BARC in all-comers TF-TAVR, but models failed for TA-TAVR outcomes.
Conclusions:
- The combined CHADS-BLED score is a robust predictor of 30-day mortality in TF-TAVR patients with AF.
- High CHADS-BLED scores effectively predict major vascular/bleeding events and CVI in TF-TAVR.
- Current risk models show limited predictive value for TA-TAVR outcomes and non-mortality events in TF-TAVR.
Background:
High CHA2DS2-VASC and HAS-BLED scores are linked to increased mortality in structural and nonstructural cardiovascular interventions irrespective of the presence of atrial fibrillation (AF) or oral anticoagulation. We aimed to use the aforementioned scores to quantify the risk of 30-day mortality, major vascular and bleeding events (MVASC/BARC), and cerebrovascular insults (CVI) in patients undergoing different access routes in transcatheter aortic valve replacement (TAVR).
Methods:
Out of 1329 patients, 980 transfemoral (TF) TAVR (73.7%) and 349 transapical (TA) TAVR (26.3%) were included. CHA2DS2-VASC, HAS-BLED, and combined "CHADS-BLED" scores were calculated and compared to the predictive value of the established EuroSCORE and STS score.
Results:
In all-comers TF TAVR patients, the applied risk models showed only poor association with 30-day mortality while, in patients with concomitant AF, a strong association was observed using the combined CHADS-BLED score (c-index: 0.83; 95% CI: 0.76-0.91; p < 0.0001). Concerning 30-day mortality, only the STS score for TF TAVR (c-index: 0.68; 95% CI: 0.59-0.76; p = 0.001) and EuroSCORE for TA TAVR (c-index: 0.66; 95% CI: 0.56-0.76; p = 0.005) could show some predictive value. High CHADS-BLED was associated with enhanced CVI (3.0% vs. 7.2%;p=0.0039 ) and more frequent MVASC/BARC (3.2% vs. 6.3%; p = 0.0362) in the all-comers TAVR cohort. All risk models failed in the prediction of CVI and MVASC/BARC for TA TAVR patients.
Conclusion:
The combined CHADS-BLED score was a strong predictor for 30-day mortality in TF TAVR patients with AF. A high CHADS-BLED score showed a good predictive value for major vascular and bleeding events as well as CVI in TF TAVR patients. This study is registered at clinical trials (NCT01805739).
