CHA2DS2-VA and non-CHA2DS2-VA components as predictors of mortality after cavotricuspid isthmus ablation: a clinical tool for long-term risk stratification

Figures

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  Figure 1. CHA2DS2-VA score distribution and mortality relationship. (A) Distribution of CHA2DS2-VA scores in the total population. (B) Relation between CHA2DS2-VA score and mortality. Each point represents the observed mortality for the corresponding score. The solid line indicates the linear trend (R2 = 0.978), showing a strong positive association between higher CHA2DS2-VA scores and mortality.

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  Figure 2. Survival analyses according to CHA2DS2-VA score. (A) Kaplan–Meier survival curves stratified by CHA2DS2-VA score. Kaplan–Meier estimates of all-cause mortality according to CHA2DS2-VA score categories. Higher CHA2DS2-VA scores were associated with progressively reduced survival during follow-up (log-rank p < 0.0001). The number of patients at risk for each score category at yearly intervals is shown below the graph. (B) Kaplan–Meier survival curves according to CHA2DS2-VA risk groups. Kaplan–Meier estimates of all-cause mortality in patients stratified into two groups based on the median CHA2DS2-VA score (Group 1: CHA2DS2-VA score <3; Group 2: CHA2DS2-VA score ≥3). Patients with higher CHA2DS2-VA scores exhibited substantially reduced survival throughout follow-up (log-rank p < 0.0001). The number of patients at risk at yearly intervals is shown beneath the figure.

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  Figure 3. Discriminatory performance of the CHA2DS2-VA score. (A) Time-dependent AUC of the CHA2DS2-VA score over 5 years of follow-up. Time-dependent area under the ROC curve (AUC) for the CHA2DS2-VA score across the follow-up period. The score maintained moderate-to-good discriminative ability for predicting all-cause mortality throughout 5 years, with AUC values generally ranging between 0.70 and 0.80. (B) Annual ROC curves for mortality prediction during Years 1–5. ROC curves illustrating the discriminative performance of the CHA2DS2-VA score for predicting 1-year, 2-year, 3-year, 4-year, and 5-year mortality. The score demonstrated consistent predictive ability over time, with similar curve shapes and no major deterioration across the follow-up years.

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  Figure 4. Univariate Cox proportional hazards analyses for predictors of all-cause mortality. (A) Hazard ratios for individual CHA2DS2-VA score components. Univariate Cox regression analysis of each CHA2DS2-VA component in relation to all-cause mortality. All variables—including congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke/TIA/thromboembolic event, vascular disease, and age 65–74 years—were significantly associated with increased mortality risk. Hazard ratios (HRs) with 95% confidence intervals are shown. (B) Hazard ratios for non-CHA2DS2-VA clinical variables. Univariate Cox regression analysis of additional comorbidities not included in the CHA2DS2-VA score. Several variables—valvular heart disease, ischemic heart disease, pulmonary disorder, renal failure, and presence of a cardiac implantable electronic device (CIED)—were significantly associated with higher mortality. Conditions including OSAS, thyroid dysfunction, GERD, dyslipidaemia, female sex and preoperative atrial fibrillation did not show significant associations. Hazard ratios (HRs) with 95% confidence intervals are displayed.