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Updated: Jan 20, 2026

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A Computational Fluid Dynamics-Based Risk Score Predicting 3-Year Cardiovascular Outcomes After Complex Left Main

Marco Zuin1,2,3, Giuseppe Marchese3, Ervis Hiso3

  • 1Department of Translational Medicine, University of Ferrara, Ferrara, Italy.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|January 19, 2026
PubMed
Summary
This summary is machine-generated.

A new CFD-based risk score, SCORE-CLM, accurately predicts cardiovascular events after complex left main bifurcation PCI. This tool aids in assessing patient risk for better treatment strategies.

Keywords:
cardiovascular mortalitycomputational fluid dynamicleft maintarget lesion revascularizationtarget vessel revascularization

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Area of Science:

  • Cardiovascular Medicine
  • Biomedical Engineering
  • Medical Imaging

Background:

  • Complex left main (LM) bifurcation lesions pose significant challenges in coronary artery disease management.
  • Suboptimal long-term outcomes after percutaneous coronary intervention (PCI) are partly attributed to undetected hemodynamic disturbances.

Purpose of the Study:

  • To develop and validate a computational fluid dynamics (CFD)-based risk score for predicting 3-year adverse cardiovascular (CV) outcomes.
  • To identify hemodynamic parameters that correlate with adverse CV events post-PCI for complex LM bifurcations.

Main Methods:

  • 211 patients with LM bifurcation disease undergoing PCI were included in this observational cohort study.
  • Patient-specific 3D models were created from coronary angiography and intravascular ultrasound for transient CFD simulations.
  • Five shear-related CFD metrics (LSS, OSI, ESSAD, helicity index, mean WSS) were extracted to form a composite risk score (SCORE-CLM).

Main Results:

  • The SCORE-CLM score (≥3) demonstrated strong predictive performance for the primary outcome (CV death, TLR, TVR) at 3 years (sensitivity 81%, specificity 85%, NPV 98%).
  • All CFD parameters significantly differed between patients with and without adverse events (p < 0.001).
  • The SCORE-CLM remained an independent predictor of adverse CV outcomes in multivariable analysis and was confirmed in an internal validation cohort.

Conclusions:

  • The Simulation-based Coronary Outcomes Risk Evaluation in Complex Left Main (SCORE-CLM) is a novel CFD-derived index.
  • SCORE-CLM accurately predicts 3-year adverse CV outcomes in patients undergoing PCI for complex LM bifurcation lesions.