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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.
Insights
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.
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.
Background:
Complex left main (LM) bifurcation lesions are among the most challenging forms of coronary artery disease, with suboptimal long-term outcomes after percutaneous coronary intervention (PCI), partly due to post-stenting hemodynamic disturbances not detected by conventional imaging.
Aims:
We developed and validated a CFD-based risk score predicting 3-year adverse cardiovascular (CV) outcomes after complex LM bifurcation PCI.
Methods:
In this observational cohort study, 211 patients undergoing successful drug-eluting stent implantation for LM bifurcation disease were included. Patient-specific 3D models were reconstructed using coronary angiography and intravascular ultrasound to perform transient CFD simulations. Five advanced shear-related metrics were extracted: low shear stress area (LSS), oscillatory shear index (OSI), endothelial shear stress angle deviation (ESSAD), helicity index, and mean wall shear stress (WSS). A composite CFD risk score (range 0-5) was created by assigning one point for each abnormal parameter. The primary endpoint was a composite of CV death, target lesion revascularization (TLR), and target vessel revascularization (TVR) at 3 years.
Results:
Over 3 years, 11.3% of patients experienced the primary outcome. All CFD parameters significantly differed between event and non-event groups (p < 0.001). A Simulation-based Coronary Outcomes Risk Evaluation in Complex Left Main (SCORE-CLM) ≥ 3 showed strong predictive performance (sensitivity 81%; specificity 85%; negative predictive value 98%) and remained an independent predictor in multivariable analysis. These findings were confirmed in an internal validation cohort.
Conclusions:
The SCORE-CLM is a novel CFD-derived risk index that accurately predicts 3-year CV outcomes in patients undergoing PCI for complex LM bifurcation lesions.
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