A novel Bail-Out Risk Score demonstrated moderate discrimination (AUC 0.731) for predicting unplanned stent implantation, which occurred in 17.0% of de novo lesions treated with DCB-only PCI.
Cohort (n=299)
A novel 6-variable bedside risk score provides a practical tool to estimate the probability of needing unplanned bail-out stenting during DCB-only PCI for de novo coronary lesions.
Effect estimate: AUC 0.731
Abstract Background Drug-coated balloon (DCB)–only percutaneous coronary intervention (PCI) has emerged as a valid stentless strategy for de novo coronary lesions. However, the need for unplanned stent implantation ("bail-out stenting") remains a procedural challenge. No dedicated bedside tool is currently available to predict this event. Objective To develop and internally validate a simple bedside Bail-Out Risk Score predicting unplanned stent implantation during DCB-only PCI. Methods A total of 299 patients (311 de novo lesions) treated with DCB-only PCI between November 2020 and February 2025 were retrospectively analyzed. Independent predictors of bail-out stenting were identified through univariate analysis, and variables with p 0.10 were entered into a multivariable logistic regression model. Regression coefficients were then transformed into integer points using the Sullivan method. Model performance was evaluated by AUC-ROC, calibration, and bootstrap internal validation (B = 1000). Results Bail-out stenting occurred in 17.0% of lesions (53/311). Independent predictors of bail-out stenting were prior CABG (OR 4.04, p = 0.006), proximal lesion location (OR 2.87, p = 0.013), and diffuse disease (OR 2.24, p = 0.037). Prior PCI (OR 0.46, p = 0.021) and lipid-lowering therapy (OR 0.40, p = 0.030) were protective, while LAD involvement showed a borderline association (OR 1.83, p = 0.061). The model demonstrated moderate discrimination (AUC = 0.731; optimism-corrected AUC = 0.699) and excellent calibration (intercept = 0.000, slope = 1.000). The final score (range –2 to +5) stratified lesions into low (≤–1), intermediate (0–2), and high (≥3) risk groups, with progressively higher predicted probabilities (≤22%, 38–74%, ≥86%). Conclusions The Bail-Out Risk Score, derived from six clinical and angiographic variables, provides a practical and reliable bedside tool to estimate procedural risk during stentless PCI.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.
Iossa et al. (Sun,) conducted a cohort in de novo coronary lesions (n=299). Bail-Out Risk Score was evaluated on unplanned stent implantation (bail-out stenting) (AUC 0.731). A novel Bail-Out Risk Score demonstrated moderate discrimination (AUC 0.731) for predicting unplanned stent implantation, which occurred in 17.0% of de novo lesions treated with DCB-only PCI.