Validation of the V-RESOLVE (Visual Estimation for Risk
prEdiction of Side Branch OccLusion in Coronary Bifurcation
interVEntion) score system
Yuan He, MD
Dong Zhang, MD
Dong Yin, MD
Chen’gang Zhu, MD
Lei Feng, MD
Chenxi Song, MD
Changzhe Chen, MD
Bo Xu, MBBS
Kefei Dou, MD
State Key Laboratory of Cardiovascular
Disease, Department of Cardiology,
Cardiovascular Institute, Fuwai Hospital and
National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences &
Peking Union Medical College, Beijing
Kefei Dou, MD, PhD, FSCAI, FACC, FESC,
and Bo Xu, MBBS, FESC, Fuwai Hospital,
National Center for Cardiovascular
Diseases, A 167, Beilishi Road, Xicheng
District, Beijing 100037, China.
Emails: email@example.com and
Yuan He and Dong Zhang contributed
equally to this work.
CAMS Innovation Fund for Medical
Sciences, Grant/Award Number: 2016-I2M-
1-009; PUMC Youth Fund & Fundamental
Research Funds for the Central
Universities, Grant/Award Number:
Objectives: This study sought to validate the V-RESOLVE score system.
Background: The V-RESOLVE score was developed to predict the risk of side branch (SB) occlu-
sion after stenting in the main vessel (MV) of coronary bifurcation lesions based on visual
estimation of the angiographic data, but it needed to be validated.
Methods: From January to June 2013, 1,286 patients with 1,820 bifurcation lesions undergoing
elective intervention with provisional strategy were included. Angiographic data before MV stent-
ing were reviewed, and the V-RESOLVE score was calculated. SB occlusion was defined as any
decrease in thrombolysis in myocardial infarction (TIMI) flow grade or the absence of flow in the
SB after MV stenting. The statistical performance of the prediction model was assessed by its dis-
crimination, calibration, and clinical usefulness.
Results: SB occlusion occurred in 222 (12.20%) of 1,820 bifurcation lesions. The discrimination of
the V-RESOLVE score for the validation cohort was good [C-statistic: 0.80, 95% confidence inter-
val (CI) 0.77–0.84]. Regarding calibration performance, the calibration-in-the-large was 20.03
(95% CI: 20.181 to 0.12), while the combined predictive effect was slightly enlarged (calibration
slope: 1.25, 95% CI: 1.081–1.41) and, mainly attributed to the stronger predictive effect of the
diameter stenosis of the SB before MV stenting. Stratified by the V-RESOLVE score, the SB occlu-
sion rate was significantly higher in the high-risk group (26.18%) than in the non-high-risk group
Conclusions: The V-RESOLVE score system is a useful tool to help risk prediction for SB occlusion
and decision-making in bifurcation intervention.
coronary bifurcation lesion, risk prediction, score system, side branch occlusion, visual estimation
Coronary bifurcation lesions account for 15%–20% of all percutaneous
coronary interventions (PCI) [1,2]. A major concern for bifurcation
intervention is to keep patency of a significant side branch (SB). While
the aggressive strategy of stenting in SB for all bifurcations is
Abbreviations: V-RESOLVE, Visual estimation for Risk prEdiction of Side
branch OccLusion in coronary bifurcation interVEntion; SB, side branch; MV,
main vessel; TIMI, thrombolysis in myocardial infarction; CI, confidence
interval; PCI, percutaneous coronary intervention; CTO, chronic total
occlusion; ROC, receiver operating characteristic; NPV, negative predictive
value; PPV, positive predictive value; CABG, coronary artery bypass grafting;
OCT, optical coherence tomography.
Yuan He and Dong Zhang contributed equally to this work.
Catheter Cardiovasc Interv. 2018;91:591–598. wileyonlinelibrary.com/journal/ccd
2018 Wiley Periodicals, Inc.
Received: 6 December 2017
Accepted: 27 December 2017