LB-5
A Novel Angiographic Scoring System Predicting Side Branch Occlusion for Left Main Bifurcation PCI: The LM V-RESOLVE Score
Presenter
Dr. Haoyu Wang, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Dr. Haoyu Wang, Jining He and Ke-Fei Dou, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Keywords: Coronary and Left Main and Bifurcation
Background
The risk of side branch (SB) occlusion is pivotal for decision-making of optimal stenting strategies during left main (LM) bifurcation PCI. Accordingly, this study aimed to develop a novel angiographic scoring system for predicting SB occlusion during LM bifurcation PCI.
Methods
A total of 855 consecutive patients undergoing unprotected LM bifurcation PCI with provisional strategy at Fuwai Hospital from January 2014 to December 2016 were recruited. A prediction model was selected by all subsets logistic regression, and a multivariable risk score (LM V-RESOLVE) was then established with incremental weights attributed to each component variable based on its estimate coefficients. SB occlusion was defined as any decrease in TIMI flow grade or absence of flow in SB after main vessel (MV) stenting.
Results
SB occlusion occurred in 19 (2.22%) LM bifurcation lesions. In multivariable model, three variables, including MV/SB diameter ratio, MV plaque ipsilateral to SB, and baseline diameter stenosis of SB, were independent predictors for SB occlusion (model C-statistics, 0.829; 95% confidence interval [CI], 0.735-0.923, with good calibration). The risk score had a C-statistics of 0.830 (95% CI, 0.738-0.923), with good calibration. Satisfactory discriminative ability of the risk score was also preserved in external validation (C-statistics, 0.794; 95%CI, 0.691-0.896).
Conclusions
The LM bifurcation-specific novel scoring system (LM V-RESOLVE), based on three simple baseline angiographic findings, could help to rapidly discriminate lesions at risk of SB occlusion during LM bifurcation PCI.
