CHA2DS2-VASc Score for Risk Stratification After Endovascular Therapy in Patients With Symptomatic Peripheral Artery Disease.

Abstract

Objective: Risk stratification after endovascular therapy (EVT) for symptomatic peripheral artery disease (PAD) remains clinically important, particularly in patients with multiple comorbidities. The CHA2DS2-VASc score is a simple clinical score that incorporates major cardiovascular risk factors, but its prognostic utility after EVT for PAD has not been well established. This study evaluated the association between the CHA2DS2-VASc score and 3-year mortality in patients undergoing EVT for symptomatic PAD.

Methods: This multicenter retrospective study included 1584 patients who underwent EVT for symptomatic PAD between 2018 and 2020. Patients were classified into low, intermediate, and high CHA2DS2-VASc score groups. The primary outcome was all-cause mortality at 3 years. Kaplan-Meier analysis and multivariable Cox proportional hazards models were used to assess the association between the score and mortality. Subgroup analyses were additionally performed according to atrial fibrillation (AF) status and PAD severity, including intermittent claudication (IC) and chronic limb-threatening ischemia (CLTI).

Results: The rates of 3-year all-cause mortality increased stepwise across the low, intermediate, and high-score groups (4.4%, 17.2%, and 25.3%, respectively; log-rank P < .001). After adjustment for PAD-specific clinical factors, the CHA2DS2-VASc score remained independently associated with all-cause mortality (hazard ratio per 1-point increase, 1.31; 95% CI, 1.21-1.43; P < .001). This association was evident in patients without AF and was also observed in both IC and CLTI subgroups.

Conclusions: In patients undergoing EVT for symptomatic PAD, a higher CHA2DS2-VASc score was independently associated with increased 3-year mortality. This widely available score may serve as a simple adjunctive tool for initial risk stratification after EVT and may complement established PAD-specific prognostic assessments.Clinical ImpactPatients undergoing endovascular therapy (EVT) for symptomatic peripheral artery disease remain at substantial risk of long-term mortality. In this multicenter study, the CHA₂DS₂-VASc score was independently associated with 3-year mortality across a broad spectrum of symptomatic PAD, including intermittent claudication and chronic limb-threatening ischemia. Although PAD- and CLTI-specific prognostic models provide superior discrimination, the CHA₂DS₂-VASc score is simple, universally recognized, and immediately available without disease-specific assessments. It may serve as an adjunctive tool for initial risk stratification and complement established prognostic models in routine clinical practice.