Terje K. Steigen1, Michael Mæng1, Rune Wiseth1, Andrejs Ērglis1, Indulis Kumsārs1, Inga Narbute1, Pål Gunnes1, Jan Mannsverk1, Oliver Meyerdierks1, Svein Rotevatn1, Matti Niemelä1, Kari Kervinen1, Jan Skov Jensen1, Anders Galløe1, Kjell Nikus1, Saila Vikman1, Jan Ravkilde1, Stefan James1, Jens Aarøe1, Antti Ylitalo1, Steffen Helqvist1, Iwar Sjögren1, Per Thayssen1, Kari Virtanen1, Mikko Puhakka1, Juhani Airaksinen1, Jens Flensted Lassen1, Leif Thuesen1
1From the Department of Cardiology, University Hospital of Tromsoe (T.K.S., J.M.), Tromsoe, Norway; Department of Cardiology, Skejby Sygehus, Aarhus University Hospital (M.M., J.R., J.F.L., L.T.), Aarhus, Denmark; Department of Cardiology, St. Olav Hospital (R.W.), Trondheim, Norway; Department of Cardiology, Paul Stradins Clinical Hospital (A.E., I.K., I.N.), Riga, Latvia; Feiring Heart Clinic (P.G.), Feiring, Norway; Department of Cardiology, Ullevaal University Hospital (O.M.), Oslo, Norway;...
Tóm tắt
Background—
The optimal stenting strategy in coronary artery bifurcation lesions is unknown. In the present study, a strategy of stenting both the main vessel and the side branch (MV+SB) was compared with a strategy of stenting the main vessel only, with optional stenting of the side branch (MV), with sirolimus-eluting stents.
Methods and Results—
A total of 413 patients with a bifurcation lesion were randomized. The primary end point was a major adverse cardiac event: cardiac death, myocardial infarction, target-vessel revascularization, or stent thrombosis after 6 months. At 6 months, there were no significant differences in rates of major adverse cardiac events between the groups (MV+SB 3.4%, MV 2.9%;
P
=NS). In the MV+SB group, there were significantly longer procedure and fluoroscopy times, higher contrast volumes, and higher rates of procedure-related increases in biomarkers of myocardial injury. A total of 307 patients had a quantitative coronary assessment at the index procedure and after 8 months. The combined angiographic end point of diameter stenosis >50% of main vessel and occlusion of the side branch after 8 months was found in 5.3% in the MV group and 5.1% in the MV+SB group (
P
=NS).
Conclusions—
Independent of stenting strategy, excellent clinical and angiographic results were obtained with percutaneous treatment of de novo coronary artery bifurcation lesions with sirolimus-eluting stents. The simple stenting strategy used in the MV group was associated with reduced procedure and fluoroscopy times and lower rates of procedure-related biomarker elevation. Therefore, this strategy can be recommended as the routine bifurcation stenting technique.
