CHA2DS2-VASc and CHA2DS2-VA Scores as Predictors of Short- and Long-Term Mortality Following Transvenous Lead Extraction

Background: Multimorbidity significantly affects prognosis in patients after transvenous lead extraction (TLE). The CHA 2 DS 2 -VASc and CHA 2 DS 2 -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 CHA 2 DS 2 -VASc and CHA 2 DS 2 -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 CHA 2 DS 2 -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 CHA 2 DS 2 -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 CHA 2 DS 2 -VASc scores (Spearman’s r = 0.983, p< 0.001). The multivariate Cox regression demonstrated that number of points on CHA 2 DS 2 -VASc and CHA 2 DS 2 -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 CHA 2 DS 2 VA 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: CHA 2 DS 2- VASc and CHA 2 DS 2- 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. Keywords: lead extraction, mortality risk, comorbidity, CHA 2 DS 2 -VASc score, cardiac implantable electronic device, risk stratification