Development and Validation of the LIFE-5S Score for Predicting 5-Year Mortality After Transvenous Lead Extraction

Long-term mortality after transvenous lead extraction (TLE) remains substantial despite high procedural success. However, simple tools for estimating long-term prognosis after successful TLE are lacking.

This retrospective multicenter study included 3368 consecutive patients undergoing TLE between 2006 and 2020 with complete 5-year follow-up. Patients were assigned in a 1:1 ratio to derivation and validation cohorts (n = 1684 each). Independent predictors of mortality were identified using multivariable Cox proportional hazards analysis and incorporated into a point-based risk score, the List of Independent Factors for Estimated 5-Year Survival (LIFE-5S). During follow-up, cumulative 5-year mortality was 32.2%. Independent predictors included male sex, older age, permanent atrial fibrillation, advanced heart failure (NYHA class III/IV), type 2 diabetes, renal dysfunction, reduced left ventricular ejection fraction, pocket infection, lead-related infective endocarditis, and the presence of cardiac resynchronization therapy. Each 1-point increase in the LIFE-5S score was associated with higher mortality risk (HR 1.36, 95% CI 1.33-1.39; p < 0.001). The model demonstrated good discrimination (AUC 0.786 in the derivation cohort and 0.785 in the validation cohort) and good calibration across score strata. To facilitate clinical application, an online calculator based on the LIFE-5S model is available (https://usuwanieelektrod.pl/life5scalculator).

The LIFE-5S score provides a simple bedside tool for long-term prognostic stratification after TLE. This model may support clinical decision-making, patient counseling, and planning of individualized follow-up strategies after TLE.