Risk Factors And Risk Assessment Of Branching Vascular Occlusion In Interventional Treatment Of Coronary Artery Bifurcation

Objectives:Bifurcation angle (BA) is thought to impact the risk of side branch (SB) occlusion in coronary bifurcation patients undergoing percutaneous coronary intervention (PCI). We aimed to investigate the effect of BA on SB occlusion after main vessel (MV) stenting.Methods:A total of 1171 consecutive patients with 1200 bifurcation lesions undergoing one stent or provisional two stent techniques were studied. The lesions were divided into low angle and high angle groups using the median BA (52°). Multivariate logistic regression analysis was performed to identify independent predictors of SB occlusion.Results:SB occlusion occurred in 88 (7.33%) of 1200 bifurcation lesions treated with the one stent technique or MV stenting first strategy. The rate of SB occlusion was significantly higher in the high angle group (63/600,10.5%) than the low angle group (25/600,4.2%) (p<0.001). The rate of SB occlusion increased significantly across quartiles of BA as follows:from 3.63% in the first quartile of BA, to 4.71% in quartile Ⅱ, to 8.14% in quartile Ⅲ to 12.97% in quartile Ⅳ (p<0.001). Multivariable analysis showed that high angle was an independent predictor of SB occlusion (odds ratio:1.026,95% confidence intervals:1.014-1.037, p<0.001). Plaque distribution at the same side of SB, MV TIMI flow grade before stenting, pre-procedural diameter stenosis of bifurcation core, diameter ratio between MV/SB and diameter stenosis of SB before MV stenting were also independent predictors of SB occlusion.Conclusions:High BA was an independent predictor of SB occlusion after MV stenting. The occlusion risk of SB with a high BA should not be ignored.Objectives:The risk of side branch (SB) occlusion is the most important consideration affecting the selection of an optimal intervention strategy. To establish a scoring system to evaluate the risk of SB occlusion in patients undergoing coronary bifurcation intervention.Methods:1545 consecutive patients undergoing percutaneous coronary intervention for bifurcation lesions (1601 lesions treated with a single stent technique or main vessel (MV) stenting first strategy) were studied.1200 lesions were used for the construction of the risk model and score system,401 lesions were used for validating the model. A multivariable risk score was constructed with incremental weights attributed to each component variable according to their estimated coefficients. SB occlusion after MV stenting was defined as any decrease in TIMI flow grade or absence of flow in SB after MV stenting.Results:SB occlusion occurred in 118 (7.37%) of 1601 bifurcation lesions. In multivariable analyses,6 variables were independently associated with the risk of SB occlusion (model C-statistic=0.80 (95% confidence interval [CI]:0.75 to 0.85) with good calibration). For the 401 lesions included in the validation cohort, the RESOLVE score had a C-statistic=0.77 (95% CI: 0.69 to 0.86), with good calibration. SB occlusion rates in the validation cohort increased significantly across different risk groups from 0.0% in the low risk group to 3.8% in the intermediate risk group, to 19.8% in the high risk group (p<0.01).Conclusions:The RESOLVE score, a novel angiographic risk stratification tool, can help identify patients at risk for SB occlusion during bifurcation intervention.Objectives: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).Methods:The present study included all the lesions (N=1,601) analyzed 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 V-RESOLVE score were derived and compared to that of the QCA-based RESOLVE score. Considering variability of visual estimation, statistical simulation of 30 different observers was performed to further assess the performance of V-RESOLVE score.Results:The SB occlusion rate was significantly higher in the high-risk group (16.7%) than the non-high-risk group (4.3%) as assessed by the V-RESOVLE 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 V-RESOLVE score was 0.76 (95%CI:0.71 to 0.80), which was comparable to the c-statistic of 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, with all 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.