Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch: the Nordic-Baltic Bifurcation Study IV.
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ABSTRACT: Background:It is still uncertain whether coronary bifurcations with lesions involving a large side branch (SB) should be treated by stenting the main vessel and provisional stenting of the SB (simple) or by routine two-stent techniques (complex). We aimed to compare clinical outcome after treatment of lesions in large bifurcations by simple or complex stent implantation. Methods:The study was a randomised, superiority trial. Enrolment required a SB?2.75?mm, ?50% diameter stenosis in both vessels, and allowed SB lesion length up to 15?mm. The primary endpoint was a composite of cardiac death, non-procedural myocardial infarction and target lesion revascularisation at 6?months. Two-year clinical follow-up was included in this primary reporting due to lower than expected event rates. Results:A total of 450 patients were assigned to simple stenting (n=221) or complex stenting (n=229) in 14 Nordic and Baltic centres. Two-year follow-up was available in 218 (98.6%) and 228 (99.5%) patients, respectively. The primary endpoint of major adverse cardiac events (MACE) at 6?months was 5.5% vs 2.2% (risk differences 3.2%, 95%?CI -0.2 to 6.8, p=0.07) and at 2?years 12.9% vs 8.4% (HR 0.63, 95%?CI 0.35 to 1.13, p=0.12) after simple versus complex treatment. In the subgroup treated by newer generation drug-eluting stents, MACE was 12.0% vs 5.6% (HR 0.45, 95%?CI 0.17 to 1.17, p=0.10) after simple versus complex treatment. Conclusion:In the treatment of bifurcation lesions involving a large SB with ostial stenosis, routine two-stent techniques did not improve outcome significantly compared with treatment by the simpler main vessel stenting technique after 2?years. Trial registration number:NCT01496638.
SUBMITTER: Kumsars I
PROVIDER: S-EPMC6999681 | biostudies-literature | 2020
REPOSITORIES: biostudies-literature
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