The Relationship Between the CHA2DS2-VASc Score and Lesion Complexity and Long-Term Outcomes in Peripheral Arterial Disease-Uncorrected Proof

OBJECTIVE
Originally designed to evaluate stroke risk in individuals with atrial fibrillation unrelated to valvular disease, the CHA2DS2-VASc score (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, prior Stroke/transient ischemic attack/systemic embolism, Vascular disease, Age 65–74 years, and Sex category – female) is now additionally utilized for the prognostic evaluation of cardiovascular diseases. This study aimed to evaluate the predictive role of the CHA2DS2-VASc score for lesion severity and long-term survival outcomes in individuals with peripheral artery disease (PAD).

METHOD
This retrospective analysis included 784 patients diagnosed with PAD via computed tomography (CT) angiography, consecutively enrolled from two medical centers. The CHA2DS2-VASc score was determined for all participants. Lesion severity was assessed according to the TASC II (Trans-Atlantic Inter-Society Consensus II) criteria, and patients were categorized into TASC-AB (simple) and TASC-CD (complex) lesion groups. Mortality data were obtained from hospital and social security records.

RESULTS
The study included 784 patients (average age: 61.7 ± 9.9 years; 17.2% female). In the regression analysis performed to predict lesion severity, we found that the CHA2DS2-VASc score (P < 0.007) and left ventricular ejection fraction (P = 0.009) were independent predictors. The receiver operating characteristic (ROC) curve indicated that a CHA2DS2-VASc score threshold of 3.5 predicted long-term mortality with 70% sensitivity and 79% specificity (P < 0.001). Kaplan-Meier survival estimates indicated that patients with higher CHA2DS2-VASc scores had significantly lower survival rates over the 60-month follow-up period (P < 0.001).

CONCLUSION
The CHA2DS2-VASc score was independently associated with both lesion severity and adverse long-term outcomes in individuals with PAD.