Safety in simple versus complex stenting of coronary artery bifurcation lesions. The nordic bifurcation study 14-month follow-up results.
OBJECTIVE
The risk of stent thrombosis has been reported to increase with percutaneous coronary intervention (PCI) complexity. The present study reports the pre-specified secondary endpoint of a 14-month stent thrombosis and major adverse cardiac events in patients stented with a simple versus a complex bifurcation technique using sirolimus eluting stents (SES).


RESULTS
A total of 413 patients with a coronary bifurcation lesion were randomised to a simple treatment strategy; stenting of main vessel and optional stenting of side branch (MV group), or to a complex stenting strategy; stenting of both main vessel and side branch (MV+SB group). Mortality data were available in all patients and 14-month clinical follow-up data in 395 (96%) of the patients. After 14 months, the rates of definite, probable and possible stent thrombosis (ARC criteria) were 1.0% vs. 0.5%, 1.0% vs. 0% and 0.5% vs. 0% (ns) in the MV and in the MV+SB groups, respectively. Rates of MACE were 9.5% in the MV group and 8.2% in the MV+SB group (ns). Total death was seen in 2.4% vs. 1.0% and non-PCI related myocardial infarction in 2.0% vs. 1.0% in the MV and the MV+SB groups, respectively.


CONCLUSIONS
After 14 months, two months after recommended cessation of dual antiplatelet therapy, the rates of stent thrombosis and major adverse cardiac events were low and independent of treatment complexity in patients treated with SES for coronary artery bifurcation lesions.
Jensen
Jan S
JS
Department of Cardiology, Gentofte University Hospital, Gentofte, Denmark.
Galløe
Anders
A
Lassen
Jens F
JF
Erglis
Andrejs
A
Kumsars
Indulis
I
Steigen
Terje K
TK
Wiseth
Rune
R
Narbute
Inga
I
Gunnes
Pål
P
Mannsverk
Jan
J
Meyerdierks
Oliver
O
Rotevatn
Svein
S
Niemelä
Matti
M
Kervinen
Kari
K
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
Thuesen
Leif
L
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003324:Coronary Artery Disease / Q000473:pathology* / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020123:Sirolimus / Q000008:administration & dosage; D013927:Thrombosis / Q000517:prevention & control; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; D020123:Sirolimus