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An angiographic tool based on Visual estimation for Risk prEdiction of Side branch OccLusion in coronary bifurcation
1State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Insights
A new visual estimation score, V-RESOLVE, accurately predicts side branch occlusion risk during bifurcation interventions. This visually estimated risk score performs comparably to the quantitative coronary angiography-based RESOLVE score, aiding real-time clinical decisions.
Area of Science:
- Interventional Cardiology
- Vascular Imaging
- Risk Stratification
Background:
- The RESOLVE score is a validated tool for assessing side branch occlusion risk in bifurcation interventions.
- Quantitative coronary angiography (QCA)-derived parameters in the RESOLVE score limit its real-time applicability.
- A need exists for a simpler, visually estimated risk assessment tool.
Purpose of the Study:
- To evaluate the risk prediction capability of a visually estimated risk score (V-RESOLVE) for side branch occlusion.
- To compare the performance of V-RESOLVE with the established QCA-based RESOLVE score.
- To assess the impact of inter-observer variability on V-RESOLVE performance.
Main Methods:
- A total of 1,601 lesions from the original RESOLVE score study were analyzed.
- An independent observer, blinded to QCA data, assigned a V-RESOLVE score to each bifurcation.
- Statistical simulations modeled inter-observer variability for 30 hypothetical observers.
Main Results:
- The V-RESOLVE score identified a significantly higher side branch occlusion rate in the high-risk group (16.7%) versus the non-high-risk group (4.3%).
- Agreement between visual estimation and QCA showed fair to moderate concordance (weighted kappa: 0.22-0.44).
- The V-RESOLVE score demonstrated a c-statistic of 0.76, comparable to the QCA-based RESOLVE score (0.77), with simulated variability yielding c-statistics from 0.65 to 0.77.
Conclusions:
- The V-RESOLVE score effectively stratifies the risk of side branch occlusion in bifurcation interventions.
- Visual estimation provides a reliable alternative to QCA-based scoring for real-time risk assessment.
- V-RESOLVE is a valuable tool for guiding procedural decisions during bifurcation interventions.
Aims:
The RESOLVE score is a validated angiographic scoring system to evaluate the risk of side branch (SB) occlusion in bifurcation intervention. However, the inclusion of quantitative coronary angiography (QCA)-derived parameters limits its use in real-time procedures. We sought to evaluate the capability of risk prediction of SB occlusion based upon a visually estimated risk score (V-RESOLVE).
Methods And Results:
The present study included all of the lesions (N=1,601) analysed in the study for development and validation of the QCA-based RESOLVE score. An independent observer, blinded to previous QCA data, performed visual estimation to derive a V-RESOLVE score for each bifurcation procedure. The performance characteristics of the V-RESOLVE score were derived and compared to those of the QCA-based RESOLVE score. Considering the variability of visual estimation, statistical simulation of 30 different observers was performed to assess the performance of the V-RESOLVE score further. The SB occlusion rate was significantly higher in the high-risk group (16.7%) than in the non-high-risk group (4.3%) as assessed by the V-RESOLVE score. The consistency between visual estimation and QCA analysis showed fair to moderate agreement (weighted kappa range: 0.22-0.44). The c-statistic of the V-RESOLVE score was 0.76 (95% CI: 0.71 to 0.80), which was comparable to the c-statistic of the QCA-based RESOLVE score (0.77, 95% CI: 0.72 to 0.81) (p=0.74 for comparison). In simulations modelling inter-observer variability, the c-statistic of the V-RESOLVE score ranged from 0.65 to 0.77, all with p<0.01.
Conclusions:
The V-RESOLVE score performs similarly to the QCA-based RESOLVE score and can help stratify the risk of SB occlusion during bifurcation intervention.
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