CHA2DS2-VA Score Predicts Mortality but Not Embolic Events in Left-Sided Infective Endocarditis

The CHA2DS2-VASc score is widely used to predict thromboembolic events in non-valvular atrial fibrillation (AF) and has also been linked to adverse outcomes in diverse clinical contexts. The latest published European Guidelines on AF recommend the simplified CHA2DS2-VA score. Embolic events (EEs) develop in up to 50% of patients with left-sided infective endocarditis (LSIE). Although several variables have been associated with in-hospital mortality and EEs, no standardized risk stratification tool is currently applied in daily practice. Therefore, we sought to assess the prognostic value of the CHA2DS2-VA score at admission for predicting both in-hospital mortality and EEs in LSIE. This study included a total of 1420 episodes of definite LSIE diagnosed across three tertiary centers. The CHA2DS2-VA score was calculated on admission for all patients. Only cases of clinical EEs occurring in the context of LSIE diagnosis and confirmed by imaging techniques were considered. In-hospital mortality was 28.8% with a stepwise increase according to the CHA2DS2-VA score (p < 0.001), regardless of AF history. Multivariable analysis identified this score as an independent predictor of mortality (OR 1.195: 95% CI 1.106–1.291). During hospitalization, 27.5% of patients experienced EEs, but no significant association was observed with the CHA2DS2-VA score (p = 0.753). In conclusion, the CHA2DS2-VA score emerges as a simple and widely available tool to identify LSIE patients at increased risk of in-hospital mortality, although it does not predict EEs.