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

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