TY - JOUR
T1 - Bifurcation left main stenting with or without intracoronary imaging
T2 - Outcomes from the EBC MAIN trial
AU - Maznyczka, Annette
AU - Arunothayaraj, Sandeep
AU - Egred, Mohaned
AU - Banning, Adrian
AU - Brunel, Philippe
AU - Ferenc, Miroslaw
AU - Hovasse, Thomas
AU - Wlodarczak, Adrian
AU - Pan, Manuel
AU - Schmitz, Thomas
AU - Silvestri, Marc
AU - Erglis, Andrejs
AU - Kretov, Evgeny
AU - Lassen, Jens Flensted
AU - Chieffo, Alaide
AU - Lefevre, Thierry
AU - Burzotta, Francesco
AU - Cockburn, James
AU - Darremont, Olivier
AU - Stankovic, Goran
AU - Morice, Marie-Claude
AU - Louvard, Yves
AU - Hildick-Smith, David
AU - EBC MAIN (European Bifurcation Club Left Main Coronary Stent study) investigators
N1 - © 2023 Wiley Periodicals LLC.
PY - 2023/9
Y1 - 2023/9
N2 - BACKGROUND: The impact of intracoronary imaging on outcomes, after provisional versus dual-stenting for bifurcation left main (LM) lesions, is unknown.OBJECTIVES: We investigated the effect of intracoronary imaging in the EBC MAIN trial (European Bifurcation Club LM Coronary Stent study).METHODS: Four hundred and sixty-seven patients were randomized to dual-stenting or a stepwise provisional strategy. Four hundred and fifty-five patients were included. Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was undertaken at the operator's discretion. The primary endpoint was death, myocardial infarction or target vessel revascularization at 1-year.RESULTS: Intracoronary imaging was undertaken in 179 patients (39%; IVUS = 151, OCT = 28). As a result of IVUS findings, operators reintervened in 42 procedures. The primary outcome did not differ with intracoronary imaging versus angiographic-guidance (17% vs. 16%; odds ratio [OR]: 0.92 (95% confidence interval [CI]: 0.51-1.63) p = 0.767), nor for reintervention based on IVUS versus none (14% vs. 16%; OR: 0.88 [95% CI: 0.32-2.43] p = 0.803), adjusted for syntax score, lesion calcification and ischemic symptoms. With angiographic-guidance, primary outcome events were more frequent with dual versus provisional stenting (21% vs. 10%; adjusted OR: 2.11 [95% CI: 1.04-4.30] p = 0.039). With intracoronary imaging, there were numerically fewer primary outcome events with dual versus provisional stenting (13% vs. 21%; adjusted OR: 0.56 [95% CI: 0.22-1.46] p = 0.220).CONCLUSIONS: In EBC MAIN, the primary outcome did not differ with intracoronary imaging versus none. However, in patients with angiographic-guidance, outcomes were worse with a dual-stent than provisional strategy When intracoronary imaging was used, there was a trend toward better outcomes with the dual-stent than provisional strategy.
AB - BACKGROUND: The impact of intracoronary imaging on outcomes, after provisional versus dual-stenting for bifurcation left main (LM) lesions, is unknown.OBJECTIVES: We investigated the effect of intracoronary imaging in the EBC MAIN trial (European Bifurcation Club LM Coronary Stent study).METHODS: Four hundred and sixty-seven patients were randomized to dual-stenting or a stepwise provisional strategy. Four hundred and fifty-five patients were included. Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was undertaken at the operator's discretion. The primary endpoint was death, myocardial infarction or target vessel revascularization at 1-year.RESULTS: Intracoronary imaging was undertaken in 179 patients (39%; IVUS = 151, OCT = 28). As a result of IVUS findings, operators reintervened in 42 procedures. The primary outcome did not differ with intracoronary imaging versus angiographic-guidance (17% vs. 16%; odds ratio [OR]: 0.92 (95% confidence interval [CI]: 0.51-1.63) p = 0.767), nor for reintervention based on IVUS versus none (14% vs. 16%; OR: 0.88 [95% CI: 0.32-2.43] p = 0.803), adjusted for syntax score, lesion calcification and ischemic symptoms. With angiographic-guidance, primary outcome events were more frequent with dual versus provisional stenting (21% vs. 10%; adjusted OR: 2.11 [95% CI: 1.04-4.30] p = 0.039). With intracoronary imaging, there were numerically fewer primary outcome events with dual versus provisional stenting (13% vs. 21%; adjusted OR: 0.56 [95% CI: 0.22-1.46] p = 0.220).CONCLUSIONS: In EBC MAIN, the primary outcome did not differ with intracoronary imaging versus none. However, in patients with angiographic-guidance, outcomes were worse with a dual-stent than provisional strategy When intracoronary imaging was used, there was a trend toward better outcomes with the dual-stent than provisional strategy.
KW - Coronary Angiography/methods
KW - Coronary Artery Disease/diagnostic imaging
KW - Humans
KW - Myocardial Infarction/etiology
KW - Percutaneous Coronary Intervention/adverse effects
KW - Stents
KW - Treatment Outcome
KW - bifurcation
KW - intravascular ultrasound
KW - percutaneous coronary intervention
KW - optical coherence tomography
KW - left main
UR - http://www.scopus.com/inward/record.url?scp=85165550392&partnerID=8YFLogxK
U2 - 10.1002/ccd.30785
DO - 10.1002/ccd.30785
M3 - Journal article
C2 - 37473405
SN - 1522-1946
VL - 102
SP - 415
EP - 429
JO - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
IS - 3
ER -