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Validation of the V-RESOLVE (Visual Estimation for Risk prEdiction of Side Branch OccLusion in Coronary Bifurcation

Yuan He¹, Dong Zhang¹, Dong Yin¹

¹State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, China.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions

|January 24, 2018

Insights

The V-RESOLVE score effectively predicts side branch occlusion risk in coronary bifurcation stenting. This validated tool aids clinical decisions for improved patient outcomes.

Area of Science:

Interventional Cardiology
Cardiovascular Imaging
Clinical Risk Prediction

Background:

Coronary bifurcation lesions pose complex stenting challenges.
Side branch (SB) occlusion is a significant complication after main vessel (MV) stenting.
The V-RESOLVE score was developed to visually estimate SB occlusion risk but required validation.

Purpose of the Study:

To validate the V-RESOLVE score system for predicting SB occlusion risk.
To assess the statistical performance (discrimination, calibration, clinical usefulness) of the V-RESOLVE score.

Main Methods:

Retrospective analysis of 1,820 bifurcation lesions from 1,286 patients undergoing elective intervention.
Calculation of the V-RESOLVE score based on pre-MV stenting angiographic data.
Statistical evaluation of the score's predictive accuracy using C-statistic, calibration plots, and risk stratification.

Main Results:

SB occlusion occurred in 12.20% of lesions.
The V-RESOLVE score demonstrated good discrimination (C-statistic: 0.80).
High-risk stratification by V-RESOLVE score correlated with significantly higher SB occlusion rates (26.18% vs. 3.48%).

Conclusions:

The V-RESOLVE score system is validated as a useful tool for risk prediction.
The score aids in decision-making during coronary bifurcation interventions.
This facilitates better management of potential SB occlusion complications.

Read full analysis

Abstract

Objectives:

This study sought to validate the V-RESOLVE score system.

Background:

The V-RESOLVE score was developed to predict the risk of side branch (SB) occlusion after stenting in the main vessel (MV) of coronary bifurcation lesions based on visual estimation of the angiographic data, but it needed to be validated.

Methods:

From January to June 2013, 1,286 patients with 1,820 bifurcation lesions undergoing elective intervention with provisional strategy were included. Angiographic data before MV stenting were reviewed, and the V-RESOLVE score was calculated. SB occlusion was defined as any decrease in thrombolysis in myocardial infarction (TIMI) flow grade or the absence of flow in the SB after MV stenting. The statistical performance of the prediction model was assessed by its discrimination, calibration, and clinical usefulness.

Results:

SB occlusion occurred in 222 (12.20%) of 1,820 bifurcation lesions. The discrimination of the V-RESOLVE score for the validation cohort was good [C-statistic: 0.80, 95% confidence interval (CI) 0.77-0.84]. Regarding calibration performance, the calibration-in-the-large was -0.03 (95% CI: -0.181 to 0.12), while the combined predictive effect was slightly enlarged (calibration slope: 1.25, 95% CI: 1.081-1.41) and, mainly attributed to the stronger predictive effect of the diameter stenosis of the SB before MV stenting. Stratified by the V-RESOLVE score, the SB occlusion rate was significantly higher in the high-risk group (26.18%) than in the non-high-risk group (3.48%).

Conclusions:

The V-RESOLVE score system is a useful tool to help risk prediction for SB occlusion and decision-making in bifurcation intervention.

Keywords:

coronary bifurcation lesion risk prediction score system side branch occlusion visual estimation

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