Validation of the V-RESOLVE (Visual Estimation for Risk prEdiction of Side Branch OccLusion in Coronary Bifurcation interVEntion) score system

Abstract

Objectives: This study sought to validate the V-RESOLVE score system. Background: The V-RESOLVE score was developed to predict the risk of side branch (SB) occlusion after stenting in the main vessel (MV) of coronary bifurcation lesions based on visual estimation of the angiographic data, but it needed to be validated. Methods: From January to June 2013, 1,286 patients with 1,820 bifurcation lesions undergoing elective intervention with provisional strategy were included. Angiographic data before MV stenting were reviewed, and the V-RESOLVE score was calculated. SB occlusion was defined as any decrease in thrombolysis in myocardial infarction (TIMI) flow grade or the absence of flow in the SB after MV stenting. The statistical performance of the prediction model was assessed by its discrimination, calibration, and clinical usefulness. Results: SB occlusion occurred in 222 (12.20%) of 1,820 bifurcation lesions. The discrimination of the V-RESOLVE score for the validation cohort was good [C-statistic: 0.80, 95% confidence interval (CI) 0.77–0.84]. Regarding calibration performance, the calibration-in-the-large was −0.03 (95% CI: −0.181 to 0.12), while the combined predictive effect was slightly enlarged (calibration slope: 1.25, 95% CI: 1.081–1.41) and, mainly attributed to the stronger predictive effect of the diameter stenosis of the SB before MV stenting. Stratified by the V-RESOLVE score, the SB occlusion rate was significantly higher in the high-risk group (26.18%) than in the non-high-risk group (3.48%). Conclusions: The V-RESOLVE score system is a useful tool to help risk prediction for SB occlusion and decision-making in bifurcation intervention.