title: Simple or complex stenting for bifurcation coronary lesions: a patient-level pooled-analysis of the Nordic Bifurcation Study and the British Bifurcation Coronary Study.
abstract: BACKGROUND
  Controversy persists regarding the correct strategy for bifurcation lesions. Therefore, we combined the patient-level data from 2 large trials with similar methodology: the NORDIC Bifurcation Study (NORDIC I) and the British Bifurcation Coronary Study (BBC ONE).
  
  
  RESULTS
  Both randomized trials compared simple (provisional T-stenting) versus complex techniques, using drug-eluting stents. In the simple group (n=457), 129 patients had final kissing balloon dilatation in addition to main vessel stenting, and 16 had T-stenting. In the complex group (n=456), 272 underwent crush, 118 culotte, and 59 T-stenting techniques. A composite end point at 9 months of all-cause death, myocardial infarction, and target vessel revascularization occurred in 10.1% of the simple versus 17.3% of the complex group (hazard ratio 1.84 [95% confidence interval 1.28 to 2.66], P=0.001). Procedure duration, contrast, and x-ray dose favored the simple approach. Subgroup analysis revealed similar composite end point results for true bifurcations (n=657, simple 9.2% versus complex 17.3%; hazard ratio 1.90 [95% confidence interval 1.22 to 2.94], P=0.004), wide-angled bifurcations >60 to 70° (n=217, simple 9.6% versus complex 15.7%; hazard ratio 1.67 [ 95% confidence interval 0.78 to 3.62], P=0.186), large (≥2.75 mm) diameter side branches (n=281, simple 10.4% versus complex 20.7%; hazard ratio 2.42 [ 95% confidence interval 1.22 to 4.80], P=0.011), longer length (>5 mm) ostial side branch lesions (n=464, simple 12.1% versus complex 19.1%; hazard ratio 1.71 [95% confidence interval 1.05 to 2.77], P=0.029), or equivalent sized vessels (side branch <0.25 mm smaller than main vessel) (n=108, simple 12.0% versus complex 15.5%; hazard ratio 1.35 [95% confidence interval 0.48 to 3.70], P=0.57).
  
  
  CONCLUSIONS
  For bifurcation lesions, a provisional single-stent approach is superior to systematic dual stenting techniques in terms of safety and efficacy. A complex approach does not appear to be beneficial in more anatomically complicated lesions.
authors.affiliation: Cardiac Department, Golden Jubilee National Hospital, Beardmore Street, Clydebank, Scotland, UK. milesbehan@hotmail.com
authors.forename: Miles W
authors.initials: MW
authors.lastname: Behan
authors.forename: Niels R
authors.initials: NR
authors.lastname: Holm
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Curzen
authors.forename: Andrejs
authors.initials: A
authors.lastname: Erglis
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Stables
authors.forename: Adam J
authors.initials: AJ
authors.lastname: de Belder
authors.forename: Matti
authors.initials: M
authors.lastname: Niemelä
authors.forename: Nina
authors.initials: N
authors.lastname: Cooter
authors.forename: Derek P
authors.initials: DP
authors.lastname: Chew
authors.forename: Terje K
authors.initials: TK
authors.lastname: Steigen
authors.forename: Keith G
authors.initials: KG
authors.lastname: Oldroyd
authors.forename: Jan S
authors.initials: JS
authors.lastname: Jensen
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome