Development and validation of a risk scoring system based on baseline angiographic results by visual estimation for risk prEdiction of side-branch OccLusion in coronary bifurcation InterVEntion: The baseline V-RESOLVE score

Abstract

Objective: We aimed to adapt the visual estimation for Risk prEdiction of side-branch OccLusion in coronary bifurcation interVEntion (V-RESOLVE) score to enable risk prediction for side-branch (SB) occlusion using only baseline coronary angiogram data.

Background: The V-RESOLVE score, which comprises angiographic factors at baseline and after lesion preparation, is a validated tool for predicting SB occlusion risk in coronary bifurcation intervention.

Methods: To develop and validate the new scoring system, we used data pertaining to 1,545 patients and another 1,286 consecutive patients. Baseline V-RESOLVE was derived from V-RESOLVE by replacing the two pre-stenting angiographic factors with the corresponding preprocedural characteristics, while maintaining the scoring standard itself. We evaluated the diagnostic performance of baseline V-RESOLVE for predicting SB occlusion and preformed risk stratification with characterization of non-high-risk and high-risk lesions.

Results: The area under the receiver operating characteristic curves was similar between baseline V-RESOLVE and V-RESOLVE (0.735 vs 0.756, P = 0.191), with good calibration for baseline V-RESOLVE (Hosmer-Lemeshow P = 0.714). Upon categorization by the baseline V-RESOLVE score, high-risk lesions (score: 14-43) demonstrated significantly higher rate of SB occlusion than did non-high-risk lesions (score: 0-13) (17.31% vs 4.74%, P < 0.01). Considering the V-RESOLVE-based risk stratification as reference, baseline V-RESOLVE had an integrated discrimination index of -1.81% (P = 0.052), and net reclassification improvement of -3.34% (P = 0.509). Upon validation, baseline V-RESOLVE provided satisfactory diagnostic performance and risk stratification.

Conclusions: Baseline V-RESOLVE predicts SB occlusion in coronary bifurcation intervention based solely on the preprocedural angiographic results.

Keywords: bifurcation lesion; percutaneous coronary intervention; risk stratification.