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CHA2DS2-VASc and CHA2DS2-VA Scores as Predictors of Short- and Long-Term Mortality Following Transvenous Lead
Celina Wojciechowska1, Łukasz Tułecki2, Wojciech Jacheć1
12nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
Insights
The CHA2DS2-VASc and CHA2DS2-VA scores effectively predict mortality risk in patients after transvenous lead extraction (TLE). Higher scores correlate with increased mortality, aiding in risk stratification and personalized patient management.
Area of Science:
- Cardiology
- Medical Devices
- Risk Stratification
Background:
- Multimorbidity impacts patient prognosis after transvenous lead extraction (TLE).
- CHA2DS2-VASc and CHA2DS2-VA scores, used for stroke risk in atrial fibrillation, contain factors linked to long-term mortality.
Purpose of the Study:
- To assess the predictive value of CHA2DS2-VASc and CHA2DS2-VA scores for short- and long-term mortality in patients undergoing non-laser TLE.
Main Methods:
- Retrospective analysis of 3822 patients undergoing non-laser TLE.
- Stratification by CHA2DS2-VASc score (<3 vs. ≥3) and assessment of 30-day, 1-year, and 3-year mortality.
- Cox proportional hazards models to identify independent predictors of death.
Main Results:
- Patients with CHA2DS2-VASc ≥3 exhibited significantly higher mortality across all follow-up periods.
- A CHA2DS2-VASc cutoff of ≥3 demonstrated 80.6% sensitivity and 62.3% specificity for 3-year mortality prediction.
- CHA2DS2-VASc and CHA2DS2-VA scores were independent predictors of long-term mortality, with each 1-point increase in CHA2DS2-VA associated with an 11.7% increased risk of death.
Conclusions:
- CHA2DS2-VASc and CHA2DS2-VA scores can aid in predicting mortality risk for patients post-TLE.
- Integrating these scores into clinical practice may enhance risk stratification and support individualized patient management.
Background:
Multimorbidity significantly affects prognosis in patients after transvenous lead extraction (TLE). The CHA2DS2-VASc and CHA2DS2-VA scores, widely used for stroke risk stratification in atrial fibrillation, include clinical factors that are also associated with long-term mortality.
Purpose:
To evaluate the usefulness of the CHA2DS2-VASc and CHA2DS2-VA scores in predicting short- and long-term mortality in patients following non-laser TLE.
Methods:
This retrospective study included 3822 patients who underwent non-laser TLE between March 2006 and April 2023 at high-volume centres. The median follow-up was 1848 days (Q1-Q3: 815-3146 days). Patients were stratified into two groups according to CHA2DS2-VASc score (<3 vs. ≥3). 30-day, 1-year, and 3-year, and overall follow-up mortality were assessed. Cox proportional hazards models were used to identify independent predictors of death during short and long follow-up.
Results:
Patients with CHA2DS2-VASc ≥3 had significantly higher mortality at 30 days 1 year, 3 years, and during overall follow-up compared with those scoring <3. A cut-off ≥3 showed 80.6% sensitivity and 62.3% specificity for predicting 3-year mortality. Mortality increased progressively with higher CHA2DS2-VASc scores (Spearman's r = 0.983, p<0.001). The multivariate Cox regression demonstrated that number of points on CHA2DS2-VASc and CHA2DS2-VA scores were independent predictors long-term mortality, alongside Charlson comorbidity index, atrial fibrillation, infective TLE indications, and renal dysfunction. Each 1-point increase in the CHA2DS2VA score was associated with an 11.7% increase in the risk of death. In sex-specific analysis, the risk increased by 33.0% per point in females (HR 1.330; p<0.001) and by 20.6% in males (HR 1.206; p<0.001).
Conclusion:
CHA2DS2-VASc and CHA2DS2-VA score may be a useful tool for predicting the risk of death during long-term observation of patients after TLE. Incorporation of this score into clinical decision-making may improve risk stratification and support individualized management of patients undergoing TLE.
