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Validation of the V-RESOLVE Score for Side Branch Occlusion in the PROGRESS-BIFURCATION Registry
Dimitrios Strepkos1, Michaella Alexandrou1, Deniz Mutlu1
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Insights
The V-RESOLVE score showed modest predictive value for side branch occlusion (SBO) during coronary bifurcation interventions. Higher scores correlated with increased SBO risk and procedural complications, though overall major adverse cardiovascular events were similar.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Coronary bifurcation interventions are complex procedures with a risk of side branch occlusion (SBO).
- The Visual estimation for Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion (V-RESOLVE) score was developed to predict SBO.
Purpose of the Study:
- To validate the V-RESOLVE score's predictive performance for SBO in an independent registry.
- To evaluate the association between V-RESOLVE scores and procedural outcomes in bifurcation percutaneous coronary interventions (PCIs).
Main Methods:
- A retrospective analysis of 791 patients undergoing 937 bifurcation PCIs from the PROGRESS-BIFURCATION registry (2014-2024).
- Comparison of patient characteristics, V-RESOLVE scores, and procedural outcomes between patients with and without SBO.
- Analysis of SBO rates across V-RESOLVE score quartiles and established cutoff values.
Main Results:
- The overall incidence of SBO was 13%.
- Patients experiencing SBO had higher V-RESOLVE scores (median 16 vs. 12), increased need for plaque modification, and higher conversion rates to two-stent strategies.
- The V-RESOLVE score demonstrated a modest predictive performance with an area under the curve (AUC) of 0.61 for SBO.
Conclusions:
- The V-RESOLVE score has a modest predictive value for SBO in the context of the PROGRESS-BIFURCATION registry.
- While higher scores are associated with increased SBO risk and procedural complexity, the score's overall discriminative ability is limited.
Background:
We validated the Visual estimation for Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion (V-RESOLVE) score for predicting side branch occlusion (SBO) in an independent registry.
Aims:
We sought to evaluate the predictive performance of the V-RESOLVE score.
Methods:
We compared the characteristics, V-RESOLVE scores, and outcomes of 791 patients (937 bifurcation PCIs) who underwent provisional bifurcation PCI performed at five centers between 2014 and 2024 from the PROGRESS-BIFURCATION registry.
Results:
The incidence of SBO was 13% (n = 124). SBO patients had lower rates of hypertension, diabetes, prior coronary artery bypass graft surgery (CABG), and prior PCI but higher angiographic complexity, with higher left anterior descending artery stenoses, lower side branch diameter, higher side branch diameter stenoses, and lower rates of ostial lesions. SBO patients had higher median V-RESOLVE scores (16 vs. 12, p < 0.001) and were more likely to convert from provisional to two-stent strategies (21.0% vs. 5.8%, p < 0.001) and to require plaque modification (37.9% vs. 18.9%, p < 0.001). SBO patients had lower technical (76.6% vs. 95.9%, p < 0.001) and procedural (72.8% vs. 92.6%, p < 0.001) success and similar in-hospital major adverse cardiovascular events (MACE) (6.1% vs. 3.8%, p = 0.306). The quartile cutoffs for V-RESOLVE scores were 9 for the first quartile of patients, 12 for the second, and 18 for the third with a maximum of 43. SBO rates were 7.5%, 9.8%, 17.5%, and 15.3% for each quartile (p < 0.001). Using the cutoff values used to develop the score (0-3, 4-7, 8-11, 12-43), the SBO rates were 7.0%, 7.0%, 8.6%, 15.7%, respectively (p < 0.001). The area under the curve (AUC) of the V-RESOLVE score for predicting SBO was 0.61 (95% confidence intervals 0.56-0.66).
Conclusions:
The predictive value of the V-RESOLVE score for SBO in the PROGRESS-BIFURCATION registry was modest.
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