The European bifurcation club Left Main Coronary Stent study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies (EBC MAIN)
| Autor: | Thomas Schmitz, Evgeny Kretov, David Hildick-Smith, Francesco Burzotta, Adrian Wlodarczak, Adrian P. Banning, James Cockburn, Mohaned Egred, Goran Stankovic, Philippe Brunel, Jens Flensted Lassen, Marc Silvestri, Yves Louvard, Miroslaw Ferenc, Olivier Darremont, Andreis Erglis, Manuel Pan, Thierry Lefèvre, Alaide Chieffo, Thomas Hovasse, Marie-Claude Morice |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Coronary Artery Disease 030204 cardiovascular system & hematology Coronary artery Coronary Angiography Revascularization 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Left coronary artery medicine.artery Coronary stent Humans Medicine 030212 general & internal medicine Myocardial infarction Left main stem business.industry Surrogate endpoint Hazard ratio Stent Angina medicine.disease Surgery Stenosis Treatment Outcome Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE Bifurcation Stents Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Heart Journal. 42:3829-3839 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehab283 |
| Popis: | Background Patients with non-left-main coronary bifurcation lesions are usually best treated with a stepwise provisional approach. However, patients with true left main stem bifurcation lesions have been shown in one dedicated randomized study to benefit from systematic dual stent implantation. Methods and results Four hundred and sixty-seven patients with true left main stem bifurcation lesions requiring intervention were recruited to the EBC MAIN study in 11 European countries. Patients were aged 71 ± 10 years; 77% were male. Patients were randomly allocated to a stepwise layered provisional strategy (n = 230) or a systematic dual stent approach (n = 237). The primary endpoint (a composite of death, myocardial infarction, and target lesion revascularization at 12 months) occurred in 14.7% of the stepwise provisional group vs. 17.7% of the systematic dual stent group (hazard ratio 0.8, 95% confidence interval 0.5–1.3; P = 0.34). Secondary endpoints were death (3.0% vs. 4.2%, P = 0.48), myocardial infarction (10.0% vs. 10.1%, P = 0.91), target lesion revascularization (6.1% vs. 9.3%, P = 0.16), and stent thrombosis (1.7% vs. 1.3%, P = 0.90), respectively. Procedure time, X-ray dose and consumables favoured the stepwise provisional approach. Symptomatic improvement was excellent and equal in each group. Conclusions Among patients with true bifurcation left main stem stenosis requiring intervention, fewer major adverse cardiac events occurred with a stepwise layered provisional approach than with planned dual stenting, although the difference was not statistically significant. The stepwise provisional strategy should remain the default for distal left main stem bifurcation intervention. Study registration http://clinicaltrials.gov NCT02497014. |
| Databáze: | OpenAIRE |
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