The European bifurcation club Left Main Coronary Sent study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies (EBC MAIN)

被引:153
作者
Hildick-Smith, David [1 ]
Egred, Mohaned [2 ]
Banning, Adrian [3 ]
Brunel, Philippe [4 ]
Ferenc, Miroslaw [5 ]
Hovasse, Thomas [6 ]
Wlodarczak, Adrian [7 ]
Pan, Manuel [8 ]
Schmitz, Thomas [9 ]
Silvestri, Marc [10 ]
Erglis, Andreis [11 ]
Kretov, Evgeny [12 ]
Lassen, Jens Flensted [13 ]
Chieffo, Alaide [14 ]
Lefevre, Thierry [6 ]
Burzotta, Francesco [15 ]
Cockburn, James [1 ]
Darremont, Olivier [16 ]
Stankovic, Goran [17 ]
Morice, Marie-Claude [6 ]
Louvard, Yves [6 ]
机构
[1] Brighton & Sussex Univ Hosp, Sussex Cardiac Ctr, Brighton, E Sussex, England
[2] Freeman Rd Hosp, Newcastle Upon Tyne, Tyne & Wear, England
[3] John Radcliffe Hosp, Oxford, England
[4] Hop Prive, Dijon, France
[5] Univ Herzzentrum Bad Krozingem, Bad Krozingen, Germany
[6] Inst Cardiovasc Paris Sud, Massy, France
[7] Poland Miedziowe Ctr Zdrowia Lubin, Lubin, Poland
[8] Univ Cordoba, Reina Sofia Hosp, Dept Cardiol, Cordoba, Spain
[9] Elisabeth Hosp Essen, Essen, Germany
[10] Hop Marseille, Marseille, France
[11] Paul Stradins Univ Hosp, Riga, Latvia
[12] Sibirskiy Fed Biomed Res Ctr Novosibirsk, Novosibirsk, Russia
[13] Univ Copenhagen, Rigshosp, Copenhagen, Denmark
[14] Ist Sci San Raffaele, Milan, Italy
[15] Univ Cattolica Sacro Cuore, Fdn Policlin Univ Gemelli, Rome, Italy
[16] Clin St Augustin Elsan, 114 Ave Ares, F-33200 Bordeaux, France
[17] Univ Belgrade, Clin Ctr Serbia, Dept Cardiol, Belgrade, Serbia
关键词
Angina; Bifurcation; Coronary artery; Left main stem; Stents; DOUBLE KISSING CRUSH; LESIONS; MULTICENTER; CONSENSUS; TRIAL;
D O I
10.1093/eurheartj/ehab283
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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. [GRAPHICS] .
引用
收藏
页码:3829 / 3839
页数:11
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