Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation study.
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.


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.
Steigen
Terje K
TK
Department of Cardiology, University Hospital of Tromsoe, Tromsoe, Norway.
Maeng
Michael
M
Wiseth
Rune
R
Erglis
Andrejs
A
Kumsars
Indulis
I
Narbute
Inga
I
Gunnes
Pål
P
Mannsverk
Jan
J
Meyerdierks
Oliver
O
Rotevatn
Svein
S
Niemelä
Matti
M
Kervinen
Kari
K
Jensen
Jan S
JS
Galløe
Anders
A
Nikus
Kjell
K
Vikman
Saila
S
Ravkilde
Jan
J
James
Stefan
S
Aarøe
Jens
J
Ylitalo
Antti
A
Helqvist
Steffen
S
Sjögren
Iwar
I
Thayssen
Per
P
Virtanen
Kari
K
Puhakka
Mikko
M
Airaksinen
Juhani
J
Lassen
Jens F
JF
Thuesen
Leif
L
D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use; D015607:Stents; D016896:Treatment Outcome
D020123:Sirolimus