| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2006;114:1955-1961.)
© 2006 American Heart Association, Inc.
Interventional Cardiology |
From 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; Department of Cardiology, Haukeland University Hospital (S.R.), Bergen, Norway; Division of Cardiology, Department of Internal Medicine, University of Oulu (M.N., K.K.), Oulu, Finland; Department of Cardiology, Gentofte University Hospital (J.S.J., A.G.), Gentofte, Denmark; Department of Cardiology, Tampere University Hospital (K.N., S.V.), Tampere, Finland; Department of Cardiology, Uppsala University Hospital (S.J.), Uppsala, Sweden; Department of Cardiology, Aalborg University Hospital (J. Aarøe), Aalborg, Denmark; Department of Cardiology, Satakunta Central Hospital (A.Y.), Pori, Finland; Department of Cardiology, Rigshospitalet (S.H.), Copenhagen, Denmark; Department of Cardiology, Falun Hospital (I.S.), Falun, Sweden; Department of Cardiology, Odense University Hospital (P.T.), Odense, Denmark; Division of Cardiology, Helsinki University Central Hospital (K.V.), Helsinki, Finland; Division of Cardiology, Kuopio University Central Hospital (M.P.), Kuopio, Finland; and Division of Cardiology, Turku University Central Hospital (J. Airaksinen), Turku, Finland.
Correspondence to Leif Thuesen, Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, 8200 Aarhus N, Denmark. E-mail leif.thuesen{at}ki.au.dk
Received September 15, 2006; revision received September 28, 2006; accepted October 3, 2006.
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.
This article has been cited by other articles:
![]() |
A. Latib and A. Colombo Bifurcation Disease: What Do We Know, What Should We Do? J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 218 - 226. [Abstract] [Full Text] [PDF] |
||||
![]() |
B.-K. Koo, K.-W. Park, H.-J. Kang, Y.-S. Cho, W.-Y. Chung, T.-J. Youn, I.-H. Chae, D.-J. Choi, S.-J. Tahk, B.-H. Oh, et al. Physiological evaluation of the provisional side-branch intervention strategy for bifurcation lesions using fractional flow reserve Eur. Heart J., March 2, 2008; 29(6): 726 - 732. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. S. Brilakis and P. B. Berger Treatment of coronary bifurcations: might less be more? Eur. Heart J., March 2, 2008; 29(6): 704 - 706. [Full Text] [PDF] |
||||
![]() |
P. S. Teirstein Unprotected Left Main Intervention: Patient Selection, Operator Technique, and Clinical Outcomes J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 5 - 13. [Abstract] [Full Text] [PDF] |
||||
![]() |
N Melikian and W Wijns Drug-eluting stents: a critique Heart, February 1, 2008; 94(2): 145 - 152. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. Tsuchikane, T. Aizawa, H. Tamai, Y. Igarashi, K. Kawajiri, N. Ozawa, S. Nakamura, K. Oku, M. Kijima, T. Suzuki, et al. Pre Drug-Eluting Stent Debulking of Bifurcated Coronary Lesions J. Am. Coll. Cardiol., November 13, 2007; 50(20): 1941 - 1945. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. Windecker and B. Meier Late Coronary Stent Thrombosis Circulation, October 23, 2007; 116(17): 1952 - 1965. [Full Text] [PDF] |
||||
![]() |
A. Colombo and A. Chieffo Drug-Eluting Stent Update 2007: Part III: Technique and Unapproved/Unsettled Indications (Left Main, Bifurcations, Chronic Total Occlusions, Small Vessels and Long Lesions, Saphenous Vein Grafts, Acute Myocardial Infarctions, and Multivessel Disease) Circulation, September 18, 2007; 116(12): 1424 - 1432. [Full Text] [PDF] |
||||
![]() |
A. Erglis, I. Narbute, I. Kumsars, S. Jegere, I. Mintale, I. Zakke, U. Strazdins, and A. Saltups A Randomized Comparison of Paclitaxel-Eluting Stents Versus Bare-Metal Stents for Treatment of Unprotected Left Main Coronary Artery Stenosis J. Am. Coll. Cardiol., August 7, 2007; 50(6): 491 - 497. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. A.G. Van Mieghem, A. Thury, W. B. Meijboom, F. Cademartiri, N. R. Mollet, A. C. Weustink, G. Sianos, P. P.T. de Jaegere, P. W. Serruys, and P. de Feyter Detection and characterization of coronary bifurcation lesions with 64-slice computed tomography coronary angiography Eur. Heart J., August 2, 2007; 28(16): 1968 - 1976. [Abstract] [Full Text] [PDF] |
||||
![]() |
S. R. Dixon, C. L. Grines, and W. W. O'Neill The Year in Interventional Cardiology J. Am. Coll. Cardiol., July 17, 2007; 50(3): 270 - 285. [Full Text] [PDF] |
||||
|
Circulation Home | Subscriptions | Archives | Feedback | Authors | Help | AHA Journals Home | Search Copyright © 2006 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. |