on October 23, 2006
Published online before print October 23, 2006, doi: 10.1161/CIRCULATIONAHA.106.664920
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Submitted on September 15, 2006
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. * To whom correspondence should be addressed. E-mail: leif.thuesen{at}ki.au.dk.
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.
Revised on September 28, 2006
Accepted on October 3, 2006
Randomized Study on Simple Versus Complex Stenting of Coronary Artery Bifurcation Lesions. The Nordic Bifurcation Study
Terje K. Steigen MD,
Key words: stents • angioplasty • angiography • restenosis • bifurcation • follow-up studies • stenosis
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