Risk Stratification in Patients with TASC II D Aortoiliac Occlusive Disease Undergoing Revascularization: Validation...

Patients with extensive aortoiliac occlusive disease (AIOD) are at high risk of long-term cardiovascular events despite successful revascularization. The CHA₂DS₂-VA score originally developed for thromboembolic risk assessment in atrial fibrillation has shown prognostic value in several cardiovascular settings, but its long-term predictive ability in aortoiliac disease remains poorly defined. This study aimed to evaluate the association between the CHA₂DS₂-VA score and long-term cardiovascular as well as limb-related outcomes in patients undergoing aortoiliac revascularization.

A prospective cohort study was conducted including patients who underwent elective aortoiliac revascularization for TransAtlantic Inter-Society Consensus II type D lesions between 2013 and 2024 at 2 centers. The CHA₂DS₂-VA score was calculated preoperatively and patients were stratified according to a predefined cut-off (≤1 vs. ≥2 points). Short-term (30-day) and long-term (60 months) outcomes were assessed, including major adverse cardiovascular events (MACE), acute heart failure (AHF), stroke, acute myocardial infarction (AMI), major adverse limb events (MALE), and all-cause mortality. Time-to-event analyses were performed using Kaplan-Meier estimates and log-rank testing. Multivariable Cox proportional hazards regression was used to identify independent predictors of long-term outcomes.

A total of 180 patients were included, predominantly males (92.6%), with a mean age of 62.5 ± 9.0 years and a median follow-up of 80 months (95% confidence interval 74.2 to 85.8), with a follow-up index of 93.9%, A CHA₂DS₂-VA score ≥2 points was significantly associated with reduced AHF-free survival (log-rank P = 0.028) and stroke-free survival (log-rank P = 0.026). No significant associations were observed between CHA₂DS₂-VA score categories and AMI, MALE, overall MACE, or all-cause mortality. On multivariable analysis, the CHA₂DS₂-VA score, when analyzed as a continuous variable, was independently associated with an increased risk of MACE. Additionally, a CHA₂DS₂-VA score ≥2 points was a strong independent predictor of stroke. The score did not independently predict limb-related outcomes.

The CHA₂DS₂-VA score suggests a clinically relevant long-term prognostic value for selected cardiovascular outcomes, particularly acute heart failure and stroke, in patients undergoing revascularization for extensive AIOD. Its simplicity and reliance on readily available clinical variables make it a useful tool for cerebrovascular and cardiovascular risk stratification in this population, although its predictive ability for limb-related events appears to be limited.