Long-term results after simple versus complex stenting of coronary artery bifurcation lesions: nordic bifurcation study 5-year follow-up results.
Selected in Journal of the American College of Cardiology by M Bollati
Maeng M, Holm NR, Erglis A, Kumsars I, Niemelä M, Kervinen K, Jensen JS, Galløe A, Steigen TK, Wiseth R, Narbute I, Gunnes P, Mannsverk J, Meyerdierks O, Rotevatn S, Nikus K, Vikman S, Ravkilde J, James S, Aarøe J, Ylitalo A, Helqvist S, Sjögren I, Thayssen P, Virtanen K, Puhakka M, Airaksinen J, Christiansen EH, Lassen JF, Thuesen L; Nordic-Baltic Percutaneous Coronary Intervention Study Group.
J Am Coll Cardiol. 2013 Jul 2;62(1):30-4
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What is known
Bifurcation lesions percutaneous coronary intervention (PCI) approach is a debated topic. Provisional stenting, with main vessel (MV) PCI only and side branch (SB) PCI by bailout, or two vessels approach (MV and SB PCI ab initio) or dedicated bifurcation stents have been proposed over the last years. At short term follow up, simple strategy (provisional stenting) looks like the best way, but longer follow up data are needed.
Maeng et al. present the 5 years follow up of NORDIC Study, comparing the randomised simple approach (Provisional, with MV+SB PCI approach only if SB TIMI flow <2) versus the complex approach (MV+SB PCI anyway).
The findings are intriguing (and expected):
- Combined safety and efficacy endpoint (cardiac death, non–procedure-related myocardial infarction, target vessel revascularisation) occurence was in favour of provisional approach (15.8% vs 21.8%, p=0.15),
- Target vessel revascularisation rate was 13.4% (provisional) versus 18.3% (p=0.14),
- Non significant different all-cause mortality (5.9% versus 10.4% p=0.16) were noted, with more stent thrombosis (also non significant) in the provisional group (3% versus 1.5%, p=0.31),
- Also in true bifurcation setting, simple strategy gives the same results as the complex strategy.
In a lot of Research fields we need answers. Regarding bifurcation PCI we were in need of confirmation. And now we have it: provisional stenting is the best way to treat a coronary bifurcation (less complexity, same results as well as the complex procedure).
However, the next question is: can dedicated bifurcation stents challenge the provisional approach?