Prognostic Value of the HELT-E₂S₂ Score in Patients with Lower Extremity Artery Disease and a Comparison with the Atrial Fibrillation and Lower Extremity Artery Disease Scores: Insight from the I-PAD NAGANO Registry

Abstract

Aims: The HELT-E₂S₂ score is a newly developed risk stratification tool for stroke in patients with atrial fibrillation. We investigated the prognostic value of the HELT-E₂S₂ score in patients with lower extremity artery disease (LEAD) and compared it with other risk scores for atrial fibrillation (AF) and LEAD.

Methods: Patients undergoing endovascular therapy (EVT) for symptomatic LEAD between August 2015 and August 2016 were enrolled in the I-PAD NAGANO registry, a prospective, multicenter, observational registry. The primary endpoint was major adverse cardiovascular events (MACEs), defined as a composite of all-cause death, nonfatal myocardial infarction, and stroke at 5 years.

Results: A total of 366 patients were divided into low-risk (HELT-E₂S₂ score ＜2, n = 146) and high-risk (HELT-E₂S₂ score ≥ 2, n = 218) groups. The major criteria of the HELT-E₂S₂ score were hypertension (81.9%) and elderly age (75-84 years old) (34.1%). The incidence of MACEs at 5 years was significantly higher in the high-risk group than in the low-risk group (43.7% vs. 22.8%, P＜0.001). In the COX multivariate analysis, the high-risk group emerged as a significant predictor of MACEs at 5 years (hazard ratio 1.87, 95% confidence interval 1.22-2.89, P = 0.004). The C-statistics for MACEs were comparable among the HELT-E₂S₂ and other AF and LEAD risk scores.

Conclusions: The HELT-E₂S₂ score was associated with an increased risk of cardiovascular events in patients with LEAD undergoing EVT.