title: An angiographic tool based on Visual estimation for Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion: the V-RESOLVE score system.
abstract: OBJECTIVE
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The V-RESOLVE score performs similarly to the QCA-based RESOLVE score and can help stratify the risk of SB occlusion during bifurcation intervention.
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors.forename: Kefei
authors.initials: K
authors.lastname: Dou
authors.forename: Dong
authors.initials: D
authors.lastname: Zhang
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.forename: Yuejin
authors.initials: Y
authors.lastname: Yang
authors.forename: Dong
authors.initials: D
authors.lastname: Yin
authors.forename: Shubin
authors.initials: S
authors.lastname: Qiao
authors.forename: Yongjian
authors.initials: Y
authors.lastname: Wu
authors.forename: Shijie
authors.initials: S
authors.lastname: You
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.forename: Ruohua
authors.initials: R
authors.lastname: Yan
authors.forename: Runlin
authors.initials: R
authors.lastname: Gao
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
mesh_terms: D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D015588:Observer Variation; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D012306:Risk