An angiographic tool based on Visual estimation for Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion: the V-RESOLVE score system.

Abstract

The RESOLVE score is a validated angiographic scoring system to evaluate the risk of side branch (SB) occlusion in bifurcation intervention. However, the inclusion of quantitative coronary angiography (QCA)-derived parameters limits its use in real-time procedures. We sought to evaluate the capability of risk prediction of SB occlusion based upon a visually estimated risk score (V-RESOLVE). The present study included all of the lesions (N=1,601) analysed in the study for development and validation of the QCA-based RESOLVE score. An independent observer, blinded to previous QCA data, performed visual estimation to derive a V-RESOLVE score for each bifurcation procedure. The performance characteristics of the V-RESOLVE score were derived and compared to those of the QCA-based RESOLVE score. Considering the variability of visual estimation, statistical simulation of 30 different observers was performed to assess the performance of the V-RESOLVE score further. The SB occlusion rate was significantly higher in the high-risk group (16.7%) than in the non-high-risk group (4.3%) as assessed by the V-RESOLVE score. The consistency between visual estimation and QCA analysis showed fair to moderate agreement (weighted kappa range: 0.22-0.44). The c-statistic of the V-RESOLVE score was 0.76 (95% CI: 0.71 to 0.80), which was comparable to the c-statistic of the QCA-based RESOLVE score (0.77, 95% CI: 0.72 to 0.81) (p=0.74 for comparison). In simulations modelling inter-observer variability, the c-statistic of the V-RESOLVE score ranged from 0.65 to 0.77, all with p<0.01. The V-RESOLVE score performs similarly to the QCA-based RESOLVE score and can help stratify the risk of SB occlusion during bifurcation intervention.