Randomized Comparisons Between Different Stenting Approaches for Bifurcation Coronary Lesions With or Without Side Branch Stenosis

Kim, Young Hak; Lee, Jae‐Hwan; Roh, Jae‐Hyung; Ahn, Jung Min; Yoon, Sung Han; Park, Duk‐Woo; Lee, Jong‐Young; Yun, Sung Cheol; Kang, Soo Jin; Lee, Seung Whan; Lee, Cheol Whan; Seung, Ki Bae; Shin, Won-Yong; Lee, Nae Hee; Lee, Bong Ki; Lee, Sang Gon; Nam, Chang Wook; Yoon, Junghan; Yang, Joo Young; Hyon, Min Su; Lee, Keun; Jang, Jae‐Sik; Kim, Hyun Sook; Park, Seong Wook; Park, Seung Jung

doi:10.1016/j.jcin.2015.01.016

Cited by 80 publications

(56 citation statements)

References 26 publications

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“…Forest plot of primary outcome: all‐cause mortality according to bifurcation treatment strategy. Nordic 2013, BBK, PERFECT , Nordic‐Baltic Bifurcation IV , BBC 1, EBC 2, Smart‐Strategy, DK Crush II 2017, DK Crush V . CI indicates confidence interval; M‐H, Mantel‐Haenszel test.…”

Section: Resultsmentioning

confidence: 99%

Single‐ Versus 2‐Stent Strategies for Coronary Bifurcation Lesions: A Systematic Review and Meta‐Analysis of Randomized Trials With Long‐Term Follow‐up

Ford

McCartney

Corcoran

et al. 2018

JAHA

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BackgroundThe majority of coronary bifurcation lesions are treated with a provisional single‐stent strategy rather than an up‐front 2‐stent strategy. This approach is supported by multiple randomized controlled clinical trials with short‐ to medium‐term follow‐up; however, long‐term follow‐up data is evolving from many data sets.Methods and ResultsMeta‐analysis of randomized controlled trials evaluating long‐term outcomes (≥1 year) according to treatment strategy for coronary bifurcation lesions. Nine randomized controlled trials with 3265 patients reported long‐term clinical outcomes at mean weighted follow‐up of 3.1±1.8 years. Provisional single stenting was associated with lower all‐cause mortality (2.94% versus 4.23%; risk ratio: 0.69; 95% confidence interval, 0.48–1.00; P=0.049; I2=0). There was no difference in major adverse cardiac events (15.8% versus 15.4%; P=0.79), myocardial infarction (4.8% versus 5.5%; P=0.51), target lesion revascularization (9.3% versus 7.6%; P=0.19), or stent thrombosis (1.8% versus 1.6%; P=0.28) between the groups. Prespecified sensitivity analysis of long‐term mortality at a mean of 4.7 years of follow‐up showed that the provisional single‐stent strategy was associated with reduced all‐cause mortality (3.9% versus 6.2%; risk ratio: 0.63; 95% confidence interval, 0.42–0.97; P=0.036; I2=0).ConclusionsCoronary bifurcation percutaneous coronary intervention using a provisional single‐stent strategy is associated with a reduction in all‐cause mortality at long‐term follow‐up.

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Section: Resultsmentioning

confidence: 99%

Single‐ Versus 2‐Stent Strategies for Coronary Bifurcation Lesions: A Systematic Review and Meta‐Analysis of Randomized Trials With Long‐Term Follow‐up

Ford

McCartney

Corcoran

et al. 2018

JAHA

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“…Potential Clinical Implications Zeus 15 and LEADERS FREE 16 Avoid bare metal stents in patients at high risk of bleeding. 30 days of DAPT with newer generation DES superior to BMS ABSORB II and III 24,25 Avoid BVS in vessels <2.25 diameter Kim et al 40 Avoid final kissing balloon in bifucations without significant disease in side branch CvLPRIT 58 , DANAMI-3 60 , PRAGUE-13 61 , EXPLORE Staged complete revascularization in the STEMI patient with multivessel disease may be safely performed but does not reduce hard endpoints Stub et al 67 AVOID routine supplimental oxygen in STEMI patients Numerous studies 15,16,[85][86][87][88][89][90][91][92] Individualize the duration of DAPT based on patient procedural risk factors for stent thrombosis MATRIX 28 Use radial access to reduce bleeding and improve survival in ACS patients MATRIX 96 Use bivalirudin to reduce bleeding and improve survival in ACS patients Carson 106 , Murphy 107 Blood transfusions are not harmful to the cardiac patient, and may improved prognosis after cardiac surgery Not surprisingly, they were used in higher risk patients, thus acute complications were increased. Long term follow-up, obtained by linking to Medicare claims data, showed similar risk adjusted death, MI and revascularization.…”

Section: Studymentioning

confidence: 99%

Percutaneous Coronary Intervention: 2015 in Review

Grines

Harjai

Schreiber

2016

J Interven Cardiology

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“…Bifurcation lesions remain one of the classic high risk lesion subset in interventional cardiology, with worse procedural success and complication rates and increased major adverse cardiac events during follow‐up compared with non‐bifurcation lesion interventions . As a consequence, the interventional treatment of bifurcation lesions is subject to ongoing debate and research …”

Section: Introductionmentioning

confidence: 99%

Application of the MADS classification system in a “mega mammoth” stent trial: Feasibility and preliminary clinical implications

Katsikis

Chichareon

Cavalcante

et al. 2018

Cathet Cardio Intervent

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Objectives and Background We attempted to test the feasibility of application of the MADS classification system in the largest stent trial to date and evaluate the preliminary clinical implications of this approach. Methods In the randomized GLOBAL LEADERS trial, testing two different antiplatelet strategies in patients undergoing PCI with bivalirudin and biolimus‐eluting stents, the e‐CRF was dedicated to bifurcation treatment according to the MADS classification. Based on this e‐CRF, the techniques used for bifurcations treatment in GLOBAL LEADERS were described and compared with two large, all‐comer registries of bifurcations treatment (I‐BIGIS and COBIS), used as historical controls. Results Among 15,991 patients enrolled in the trial, 22,921 lesions treated at the index and staged procedure were available for analysis and 2,757 of these lesions were bifurcations and 7 were trifurcation lesions. The e‐CRF‐based MADS classification was achieved in 2,757 of these lesions (100%). 80.3% of bifurcations were treated using a single stent, 18.9% using 2 stents and 0.7% using 3 stents. Overall, the “main across side first” approach (A) was used in 77.4% with the “side branch first” approach (S) being the second most frequently used technique (10.2%). A single stent was used in the majority of the “A” approach (87.9%). A reduction in the use of 2‐stent techniques (from 33.9 to 18.9%) was observed between GLOBAL LEADERS and I‐BIGIS. The “A” approach was the most frequently used technique in GLOBAL LEADERS, while in COBIS the “S” strategy was most frequently employed. Conclusions Application of the MADS classification through an e‐CRF was feasible in the largest stent trial today and provided useful information about the trends observed overtime in the treatment of bifurcation lesions.

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Randomized Comparisons Between Different Stenting Approaches for Bifurcation Coronary Lesions With or Without Side Branch Stenosis

Abstract: Angiographic and clinical outcomes were excellent after percutaneous coronary intervention using drug-eluting stents with any stent technique for non-left main bifurcation lesions once the procedure was performed successfully.

Cited by 80 publications

References 26 publications

Single‐ Versus 2‐Stent Strategies for Coronary Bifurcation Lesions: A Systematic Review and Meta‐Analysis of Randomized Trials With Long‐Term Follow‐up

Single‐ Versus 2‐Stent Strategies for Coronary Bifurcation Lesions: A Systematic Review and Meta‐Analysis of Randomized Trials With Long‐Term Follow‐up

Percutaneous Coronary Intervention: 2015 in Review

Application of the MADS classification system in a “mega mammoth” stent trial: Feasibility and preliminary clinical implications

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