Accuracy of RESOLVE score derived from coronary computed tomography versus visual angiography to predict side branch
Maksymilian P Opolski1, Kajetan Grodecki2, Adam D Staruch1
1Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
Insights
The quantitative coronary computed tomography angiography (CTA)-derived RESOLVE score accurately predicts side branch (SB) occlusion during coronary bifurcation intervention. This CTA-derived score is a reliable alternative to the V-RESOLVE score derived from angiography.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- The V-RESOLVE score, based on visual estimation from angiography, is a validated tool for predicting side branch (SB) occlusion in coronary bifurcation interventions.
- Data regarding the utility of coronary computed tomography angiography (CTA) in guiding percutaneous coronary intervention (PCI) for bifurcation lesions remains limited.
Purpose of the Study:
- To validate the predictive capability of a quantitative CTA-derived RESOLVE score for SB occlusion during coronary bifurcation intervention.
- To compare the predictive performance of the CTA-derived RESOLVE score against the established angiography-based V-RESOLVE score.
Main Methods:
- A study included 363 patients with 400 bifurcation lesions.
- Both angiographic V-RESOLVE and CTA-derived RESOLVE scores were calculated using established weights.
- Accuracy was evaluated using areas under the receiver-operator characteristic curve (AUC), with SB occlusion defined by decreased Thrombolysis in Myocardial Infarction (TIMI) flow grade post-stenting.
Main Results:
- Twenty-eight cases (7%) of SB occlusion were observed.
- The CTA-derived RESOLVE score demonstrated comparable predictive accuracy to the V-RESOLVE score (AUC 0.709 vs. 0.752, p=0.531).
- No significant differences were found in SB occlusion rates between the high-risk and non-high-risk groups defined by either scoring system.
Conclusions:
- The quantitative CTA-derived RESOLVE score is a precise and dependable method for predicting SB occlusion in coronary bifurcation interventions.
- CTA-derived RESOLVE score offers a viable alternative to angiography-based V-RESOLVE score for risk stratification in these procedures.
Introduction:
Visually estimated angiographic V-RESOLVE score was developed as a simple and accurate prediction tool for side branch (SB) occlusion in patients undergoing coronary bifurcation intervention. Data on the use of coronary computed tomography angiography (coronary CTA) for guiding percutaneous coronary intervention in bifurcation lesions is scarce.
Objectives:
We aimed to validate the ability of quantitative CTA-derived RESOLVE score for predicting SB occlusion in coronary bifurcation intervention and to compare its predictive value with that of the angiography-based V-RESOLVE score.
Methods:
We included 363 patients with 400 bifurcation lesions. Angiographic V-RESOLVE score and CTA-derived RESOLVE score were calculated utilizing the weights from the QCA-based RESOLVE score. The scoring systems were divided into quartiles, and classified as the non-high-risk group and the high-risk group. Accuracy was assessed using areas under the receiver-operator characteristic curve (AUC). SB occlusion was defined as any decrease in Thrombolysis in Myocardial Infarction flow grade (including the absence of flow) in the SB after main vessel stenting.
Results:
In total, 28 SB occlusions (7%) occurred. CTA-derived RESOLVE and V-RESOLVE scores achieved comparable predictive accuracy (0.709 vs. 0.752, respectively, p = 0.531) for predicting SB occlusion, and the analysis of AUC for each constituent element of the scores did not show any significant difference between CTA and visual angiography. The total net reclassification index was -18.6% (p = 0.194), and there were no significant differences in the rates of SB occlusion in the non-high-risk group (4.9% vs. 3.8%, p = 0.510) and the high-risk group (13.8% vs. 18.6%, p = 0.384) between CTA-derived RESOLVE and V-RESOLVE scores.
Conclusions:
The quantitative CTA-derived RESOLVE score is an accurate and reliable alternative to the visually estimated angiographic V-RESOLVE score for prediction of SB occlusion in coronary bifurcation intervention.
Clinical Trial Registration:
URL: https://www.clinicaltrials.gov. Unique identifier: NCT03709836.
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