Validation of the V-Resolve Score for Side Branch Occlusion in the Progress-Bifurcation Registry

Abstract

Background We validated the Visual estimation for Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion (V-RESOLVE) score for predicting side branch occlusion (SBO) in an independent registry. Aims We sought to evaluate the predictive performance of the V-RESOLVE score. Methods We compared the characteristics, V-RESOLVE scores, and outcomes of 791 patients (937 bifurcation PCIs) who underwent provisional bifurcation PCI performed at five centers between 2014 and 2024 from the PROGRESS-BIFURCATION registry.ResultsThe incidence of SBO was 13% (n = 124). SBO patients had lower rates of hypertension, diabetes, prior coronary artery bypass graft surgery (CABG), and prior PCI but higher angiographic complexity, with higher left anterior descending artery stenoses, lower side branch diameter, higher side branch diameter stenoses, and lower rates of ostial lesions. SBO patients had higher median V-RESOLVE scores (16 vs. 12, p < 0.001) and were more likely to convert from provisional to two-stent strategies (21.0% vs. 5.8%, p < 0.001) and to require plaque modification (37.9% vs. 18.9%, p < 0.001). SBO patients had lower technical (76.6% vs. 95.9%, p < 0.001) and procedural (72.8% vs. 92.6%, p < 0.001) success and similar in-hospital major adverse cardiovascular events (MACE) (6.1% vs. 3.8%, p = 0.306). The quartile cutoffs for V-RESOLVE scores were 9 for the first quartile of patients, 12 for the second, and 18 for the third with a maximum of 43. SBO rates were 7.5%, 9.8%, 17.5%, and 15.3% for each quartile (p < 0.001). Using the cutoff values used to develop the score (0-3, 4-7, 8-11, 12-43), the SBO rates were 7.0%, 7.0%, 8.6%, 15.7%, respectively (p < 0.001). The area under the curve (AUC) of the V-RESOLVE score for predicting SBO was 0.61 (95% confidence intervals 0.56-0.66). Conclusions The predictive value of the V-RESOLVE score for SBO in the PROGRESS-BIFURCATION registry was modest.