Scoring System for Predicting the Risk of Side Branch Occlusion Based on Angiographic Visual Estimation in Coronary Bifurcation Intervention
10.3969/j.issn.1000-3614.2017.12.004
- VernacularTitle:基于造影目测结果评估冠状动脉分叉病变介入治疗中分支闭塞风险评分系统的研究
- Author:
Yuan HE
1
;
Dong ZHANG
;
zhe Chang CHEN
;
xi Chen SONG
;
Dong YIN
;
Lei FENG
;
gang Cheng ZHU
;
Bo XU
;
fei Ke DOU
Author Information
1. 北京协和医学院 中国医学科学院 国家心血管病中心 阜外医院 冠心病诊治中心
- Keywords:
Coronary artery disease;
Risk assessment;
Scoring system
- From:
Chinese Circulation Journal
2017;32(12):1158-1162
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To establish a scoring system for predicting the risk of side branch occlusion(SBO) in coronary bifurcation intervention based on visual estimation of quantitative coronary angiography (QCA). Methods: RESOLVE scoring system was developed from QCA. A total of 1545 patients with 1601 bifurcation lesions by RESOLVE study were enrolled. Based on RESOLVE scoring system, visual estimation was conducted to compare the consistency. According to SBO occurrence after main branch stent implantation, our research was divided into 2 groups: SBO group, which was defined by coronary angiography confirmed TIMI grade decreasing, n=114 patients with 118 lesions and Non-SBO group, n=1431 patients with 1483 lesions. Using RESOLVE scoring method as reference,V-RESOLVE scoring system was established, the discrimination, goodness-of-fit and V-RESOLVE score for the incidence of SBO were assessed;the diagnostic value for predicting the risk of SBO in coronary bifurcation intervention was compared between 2 scoring systems. Results: The consistency between visual and QCA was from fair to moderate (weighted Kappa=0.22-0.44). Compared with Non-SBO group, SBO group had the higher degrees of pre-operative bifurcation stenosis and side branch stenosis before main branch stent implantation; larger bifurcation angle and vessel diameters in main/side branches, all P<0.01. The area of V-RESOLVE under ROC curve was 0.76(95%CI 0.71-0.81) which was similar to the area of RESOLVE under ROC curve:0.77 (95% CI 0.72-0.81), P=0.74, Hosmer-Lemeshow P=0.17. The patients were categorized into 2 conditions by V-RESOLVE: high risk (V-RESOLVE score≥12)and non-high risk (V-RESOLVE score<12), the incidence of SBO was higher in high risk patients (16.7% vs 4.3%), P<0.01. The incidences of SBO were similar in non-high risk patients by V-RESOLVE and RESOLVE (4.3% vs 3.4%), P=0.22 and in high risk patients (16.7% vs 18.0%), P=0.60. Conclusion: V-RESOLVE scoring system may predict the risk of SBO in patients with coronary bifurcation intervention.
