Bifurcation left main stenting with or without intracoronary imaging: Outcomes from the EBC MAIN trial.

Autor: Maznyczka A; Leeds General Infirmary, Leeds, UK., Arunothayaraj S; Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK., Egred M; Freeman Hospital, Newcastle upon Tyne, UK., Banning A; John Radcliffe Hospital, Oxford, UK., Brunel P; Hopital Prive, Dijon, France., Ferenc M; Universitats-Herzzentrum Bad Krozingem, Bad Krozingen, Germany., Hovasse T; Institute Cardiovasculaire Paris Sud, Massy, France., Wlodarczak A; Poland Miedziowe Centrum Zdrowia Lubin, Lubin, Poland., Pan M; Department of Cardiology, Reina Sofia Hospital, (IMIBIC), University of Cordoba, Cordoba, Spain., Schmitz T; Elisabeth Hospital Essen, Essen, Germany., Silvestri M; Clinique Axium, Aix en Provence, France., Erglis A; Paul Stradins University hospital, Riga, Latvia., Kretov E; Sibirsky Federal Biomedical Research Center Novosibrisk, Novosibirsk, Russia., Lassen JF; Rigshospitalet University of Copenhagen, Copenhagen, Denmark., Chieffo A; °San Raffaele Sciientific Institute, Milan, Italy., Lefevre T; Institute Cardiovasculaire Paris Sud, Massy, France., Burzotta F; Fondazione Policlinico Universitario A. Genelli, Universita Cattolica del Sacro Cuore, Rome, Italy., Cockburn J; Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK., Darremont O; Clinique Saint-Augustin-Elsan, Bordeux, France., Stankovic G; Departmenet of Cardiology, Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia., Morice MC; Institute Cardiovasculaire Paris Sud, Massy, France., Louvard Y; Institute Cardiovasculaire Paris Sud, Massy, France., Hildick-Smith D; Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK.
Jazyk: angličtina
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2023 Sep; Vol. 102 (3), pp. 415-429. Date of Electronic Publication: 2023 Jul 20.
DOI: 10.1002/ccd.30785
Abstrakt: Background: The impact of intracoronary imaging on outcomes, after provisional versus dual-stenting for bifurcation left main (LM) lesions, is unknown.
Objectives: We investigated the effect of intracoronary imaging in the EBC MAIN trial (European Bifurcation Club LM Coronary Stent study).
Methods: Four hundred and sixty-seven patients were randomized to dual-stenting or a stepwise provisional strategy. Four hundred and fifty-five patients were included. Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was undertaken at the operator's discretion. The primary endpoint was death, myocardial infarction or target vessel revascularization at 1-year.
Results: Intracoronary imaging was undertaken in 179 patients (39%; IVUS = 151, OCT = 28). As a result of IVUS findings, operators reintervened in 42 procedures. The primary outcome did not differ with intracoronary imaging versus angiographic-guidance (17% vs. 16%; odds ratio [OR]: 0.92 (95% confidence interval [CI]: 0.51-1.63) p = 0.767), nor for reintervention based on IVUS versus none (14% vs. 16%; OR: 0.88 [95% CI: 0.32-2.43] p = 0.803), adjusted for syntax score, lesion calcification and ischemic symptoms. With angiographic-guidance, primary outcome events were more frequent with dual versus provisional stenting (21% vs. 10%; adjusted OR: 2.11 [95% CI: 1.04-4.30] p = 0.039). With intracoronary imaging, there were numerically fewer primary outcome events with dual versus provisional stenting (13% vs. 21%; adjusted OR: 0.56 [95% CI: 0.22-1.46] p = 0.220).
Conclusions: In EBC MAIN, the primary outcome did not differ with intracoronary imaging versus none. However, in patients with angiographic-guidance, outcomes were worse with a dual-stent than provisional strategy When intracoronary imaging was used, there was a trend toward better outcomes with the dual-stent than provisional strategy.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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