Validation of the VRESOLVE Score for Side Branch Occlusion in the PROGRESS-BIFURCATION Registry

Abstract

BACKGROUND: The VRESOLVE score predicts the risk of side branch occlusion (SBO) in provisional bifurcation percutaneous coronary intervention (PCI) using visual estimation of angiographic data. We evaluated the VRESOLVE score in an independent registry.METHODS: We examined the clinical and procedural characteristics and outcomes of 636 patients (748 bifurcation PCIs) performed in 5 centers between 2014 and 2023 from the PROGRESS-BIFURCATION (Prospective Global Registry for the Study of Bifurcation Lesion Interventions). RESULTS Of the included patients, 89 (14%) had SBO. These patientswere less likely to have hypertension (81.1% vs 68.2%; P ¼ 0.005) and diabetes (34.8% vs 23.9%; P ¼ 0.043). SBO bifurcations had higher VRESOLVE scores (12 vs 17; P < 0.001), had more severe proximal main vessel diameter stenosis (80% vs 75%%; P ¼ 0.013) and side branch diameter stenosis (30% vs 79%; P < 0.001), and were more likely to be located in the left anterior descending artery. They also had lower rates of ostial coronary lesions (8.1% vs 1.1%) and pretreatment intravascular imaging, and had smaller SB diameter. The mean VRESOLVE score was 9 for the first quartile of patients, 13 for the second, and 19 for the third, with a maximum (fourth) of 43. SBO rates were 7.1%, 9.6%, 20.8%, and 14.7%, respectively (P < 0.001). Using the values used for developing the score (0-3, 4-7, 8-11, 12-43), SBO rates were 4.1%, 7.8%, 8.9%, and 16.1% (P ¼ 0.004). The AUC of the VRESOLVE score for predicting SBO was 0.62 (0.56-0.67).CONCLUSION The VRESOLVE score has a modest predictive value for SBO in the PROGRESS-BIFURCATION registry.