Impact of the repositionable Evolut R CoreValve system on the need for a permanent pacemaker after transcatheter aortic valve implantation in patients with severe aortic stenosis.

OBJECTIVES: To compare the incidence of permanent pacemaker implantation (PPI) with the CoreValve and Evolut R prostheses, to evaluate the implantation depth with both types of prostheses, and to study factors predicting the need for PPI. BACKGROUND: The Evolut R CoreValve can be recaptured and repositioned during deployment, allowing a more precise implantation. METHODS: A total of 208 patients treated with CoreValve and 137 patients treated with Evolut R were analyzed. The depth of the prosthesis in the LVOT was measured by angiography in the annular perpendicular view projection after deploymen in all patients. RESULTS: Baseline conduction abnormalities were comparable between the groups (85/208, 40.9% vs. 53/137, 38.7%; p = 0.69). The mean prosthesis depth was 10.3 ± 8.6 mm in the CoreValve group and 5.5 ± 2.7 mm in the Evolut R group; p < 0.0001. Conduction disturbances after valve implantation were more frequent with the CoreValve (new-onset left bundle branch block: 93, 44.7% vs. 16, 11.7%; p < 0.05, first-degree atrioventricular block: 23, 11.1% vs. 5, 3.6%; p < 0.05). In addition, the incidence of PPI was significantly lower with Evolut R (45, 21.6% vs. 15, 10.9%; p = 0.01). The predictors of the need for PPI were the mean depth of the prosthesis (OR: 1.13, 95% CI: 1.06-1.21; p < 0.0001) and prior right bundle branch block (OR 10.22, 95% CI: 4.62-22.63; p < 0.0001). CONCLUSIONS: The recapturable capability of the Evolut R system allowed for higher and precise valve implantation. This fact had an impact on the reduction in the need for PPI.

Percutaneous reintervention on aortic coarctation stenting.

AIMS: The aim of this study was to assess the efficacy and safety of percutaneous reintervention in patients who underwent aortic coarctation stenting at an early age. METHODS AND RESULTS: From 1993 to 2018, 177 patients with aortic coarctation were treated with stent implantation at our centre; 33 of them were treated at less than 12 years of age and required reintervention because of their rate of growth. The average age of the patients at the first and second procedure was 6±3 years and 19±7 years, respectively. At the reintervention procedure, 15 (45%) patients were treated with balloon re-expansion, and 18 (55%) were treated with re-stenting. Success was obtained in 30 patients (91%). The gradient across the coarctation changed from 22±10 mmHg to 6±6 mmHg, while the minimal lumen diameter increased from 9±6 mm to 15±3 mm. There were eight occlusions of the femoral artery (after the first procedure), and two covered stents were needed because of femoral bleeding. The mean follow-up time after the second procedure was 5±4 years. A third procedure was required only in three patients (9%). CONCLUSIONS: Patients with aortic coarctation treated with stent placement at an early age can be successfully re-treated after the completion of their somatic growth.

Spanish Results of the Second European Cardiac Resynchronization Therapy Survey (CRT-Survey II).

INTRODUCTION AND OBJECTIVES: We describe the results for Spain of the Second European Cardiac Resynchronization Therapy Survey (CRT-Survey II) and compare them with those of the other participating countries. METHODS: We included patients undergoing CRT device implantation between October 2015 and December 2016 in 36 participating Spanish centers. We registered the patients' baseline characteristics, implant procedure data, and short-term follow-up information until hospital discharge. RESULTS: Implant success was achieved in 95.9%. The median [interquartile range] annual implantation rate by center was significantly lower in Spain than in the other participating countries: 30 implants/y [21-50] vs 55 implants/y [33-100]; P=.00003. In Spanish centers, there was a lower proportion of patients ≥ 75 years (27.9% vs 32.4%; P=.0071), a higher proportion in New York Heart Association functional class II (46.9% vs 36.9%; P <.00001), and a higher percentage with electrocardiographic criteria of left bundle branch block (82.9% vs 74.6%; P <.00001). The mean length of hospital stay was significantly lower in Spanish centers (5.8±8.5 days vs 6.4±11.6; P <.00001). Spanish patients were more likely to receive a quadripolar LV lead (74% vs 56%; P <.00001) and to be followed up by remote monitoring (55.8% vs 27.7%; P <.00001). CONCLUSIONS: The CRT-Survey II shows that, compared with other participating countries, fewer patients in Spain aged ≥ 75 years received a CRT device, while more patients were in New York Heart Association functional class II and had left bundle branch block. In addition, the length of hospital stay was shorter, and there was greater use of quadripolar LV leads and remote CRT monitoring.

Role of copy number variants in sudden cardiac death and related diseases: genetic analysis and translation into clinical practice.

Several studies have identified copy number variants (CNVs) as responsible for cardiac diseases associated with sudden cardiac death (SCD), but very few exhaustive analyses in large cohorts of patients have been performed, and they have been generally focused on a specific SCD-related disease. The aim of the present study was to screen for CNVs the most prevalent genes associated with SCD in a large cohort of patients who suffered sudden unexplained death or had an inherited cardiac disease (cardiomyopathy or channelopathy). A total of 1765 European patients were analyzed with a homemade algorithm for the assessment of CNVs using high-throughput sequencing data. Thirty-six CNVs were identified (2%), and most of them appeared to have a pathogenic role. The frequency of CNVs among cases of sudden unexplained death, patients with a cardiomyopathy or a channelopathy was 1.4% (8/587), 2.3% (20/874), and 2.6% (8/304), respectively. Detection rates were particularly high for arrhythmogenic cardiomyopathy (5.1%), long QT syndrome (4.7%), and dilated cardiomyopathy (4.4%). As such large genomic rearrangements underlie a non-neglectable portion of cases, we consider that their analysis should be performed as part of the routine genetic testing of sudden unexpected death cases and patients with SCD-related diseases.

One Versus 2-stent Strategy for the Treatment of Bifurcation Lesions in the Context of a Coronary Chronic Total Occlusion. A Multicenter Registry.

INTRODUCTION AND OBJECTIVES: There is little evidence on the optimal strategy for bifurcation lesions in the context of a coronary chronic total occlusion (CTO). This study compared the procedural and mid-term outcomes of patients with bifurcation lesions in CTO treated with provisional stenting vs 2-stent techniques in a multicenter registry. METHODS: Between January 2012 and June 2016, 922 CTO were recanalized at the 4 participating centers. Of these, 238 (25.8%) with a bifurcation lesion (side branch ≥ 2mm located proximally, distally, or within the occluded segment) were treated by a simple approach (n=201) or complex strategy (n=37). Propensity score matching was performed to account for selection bias between the 2 groups. Major adverse cardiac events (MACE) consisted of a composite of cardiac death, myocardial infarction, and clinically-driven target lesion revascularization. RESULTS: Angiographic and procedural success were similar in the simple and complex groups (94.5% vs 97.3%; P=.48 and 85.6% vs 81.1%; P=.49). However, contrast volume, radiation dose, and fluoroscopy time were lower with the simple approach. At follow-up (25 months), the MACE rate was 8% in the simple and 10.8% in the complex group (P=.58). There was a trend toward a lower MACE-free survival in the complex group (80.1% vs 69.8%; P=.08). After propensity analysis, there were no differences between the groups regarding immediate and follow-up results. CONCLUSIONS: Bifurcation lesions in CTO can be approached similarly to regular bifurcation lesions, for which provisional stenting is considered the technique of choice. After propensity score matching, there were no differences in procedural or mid-term clinical outcomes between the simple and complex strategies.

Restenosis After Everolimus-eluting Vascular Scaffolding. Angiographic and Optical Coherence Tomography Characterization.

INTRODUCTION AND OBJECTIVES: Coronary restenosis after bioresorbable vascular scaffold (BVS) implantation is infrequent and little information is available on the main characteristics of these lesions. The aim of this study was to assess restenotic lesions by using optical coherence tomography (OCT). METHODS: We studied 330 patients with coronary artery disease who received 398 BVS to treat 380 lesions. These patients were clinically and angiographically evaluated at follow-up and OCT was carried out on detection of restenosis. RESULTS: After a follow-up of 19 ± 10 months, 18 restenotic lesions were detected in 17 patients (5.4%). Depending on the time of presentation, most cases of restenosis were late or very late (9 ± 4 months). The most frequent angiographic pattern was focal restenosis in 12 (67%) patients, which was mainly located at the proximal border in 9 (75%) whether involving the scaffold or not. The homogeneous pattern was infrequent, occurring in 3 (25%) lesions and was only visualized in 3 out of 6 cases of restenosis located at the margin. When the focal restenosis was located in the platform, OCT showed a heterogeneous or layered pattern. Finally, diffuse restenosis was observed in 6 patients (33%). In diffuse restenosis, OCT revealed a lipid-laden or layered tissue structure and the presence of microvessels or microcalcification, potentially suggesting a neoatherosclerotic process. CONCLUSIONS: After a mean follow-up of 19 months, the restenosis rate was 5.4%. Most restenotic lesions were focal, located at the proximal border. Diffuse restenosis mostly occurred late or very late and most showed signs suggestive of neoatherosclerosis.

Bifurcation lesions involved in the recanalization process of coronary chronic total occlusions: Incidence, treatment and clinical implications.

BACKGROUND: The presence of a bifurcation (BL) in the context of a coronary chronic total occlusion (CTO) represents an additional difficulty. This study analyzes the incidence of BLs in CTO recanalization, the treatment, predictors of bifurcation technical success and their clinical impact. METHODS AND RESULTS: BLs with a side branch (SB) ≥2.0mm located proximally, distally or within the occluded segment were observed in 130 (33%) of 391 CTO. Provisional stenting was the strategy more frequently used (94%). Bifurcation success (stenosis <30% in main vessel and TIMI flow III in both branches) was achieved in 105 patients (81%). In the remaining 25 (19%), the TIMI flow at the SB was

Structural Damage of Jailed Guidewire During the Treatment of Coronary Bifurcation Lesions: A Microscopic Randomized Trial.

OBJECTIVES: The study sought to compare the safety (resistance to damage) and efficacy (ability to cross the side branch) of polymer-coated and non-polymer-coated guidewires in the jailed wire technique used during the percutaneous treatment of bifurcation lesions. BACKGROUND: The jailed wire technique is a useful strategy in the treatment of bifurcation lesions by provisional stenting. However, these wires can be damaged or even be broken during their removal. METHODS: We performed a randomized study in patients with bifurcation lesions treated by provisional stenting. The jailed wire technique was mandatory, and the types of guidewires, polymer-coated (n = 115) and non-polymer-coated (n = 120), were randomized. After the procedures, the wires were evaluated by stereoscopic microscopy. The induced damage in the wires was classified as follows: no damage, mild, moderate, or severe. RESULTS: The clinical characteristics were similar between patients treated with polymer-coated or non-polymer-coated wires. Polymer-coated wires were significantly (p < 0.001) more resistant to retrieval damage (only 2 wires showed mild damage) than were non-polymer-coated wires. However, 63 (55%) of the non-polymer-coated wires were damaged; 37 (32%), 24 (21%), and 2 (2%) had mild, moderate, and severe damage, respectively. Additionally, the jailed length of the wire was a factor contributing to the degree of wire damage. The time of side branch wiring was shorter in the polymer-coated wire group (19 ± 40 s vs. 42 ± 72 s; p < 0.05). CONCLUSIONS: Jailed wires during interventional procedures of bifurcation lesions commonly showed microscopic damage. Polymer-coated wires were more resistant to retrieval damage and were more efficient in crossing the side branch ostium than non-polymer-coated wires. (Jailed Wire Technique in the Treatment of Coronary Bifurcations Lesions With Stent: Stereoscopic Microscopy Study; NCT02516891).

Bioresorbable Vascular Scaffold for the Treatment of Coronary Bifurcation Lesions: Immediate Results and 1-year Follow-up.

INTRODUCTION AND OBJECTIVES: The treatment of coronary lesions with a bioresorbable vascular scaffold has been shown to be effective. However there is little information about its use in bifurcations. The aim of this study was to analyze the safety and efficacy of the bioresorbable scaffold in the treatment of coronary bifurcation lesions. METHODS: From January 2012 to January 2015, we used a bioresorbable vascular scaffold to treat 194 patients with 230 bifurcation lesions. The scaffold geometry was examined by intracoronary imaging techniques in 145 bifurcations (65%). In all, 78% of the bifurcations were evaluated angiographically during follow-up (computed tomography angiography in 138 and coronary angiography in 41). RESULTS: The most common clinical presentation was acute coronary syndrome (81%). The most frequent type of bifurcation was 1,1,1 (34%). A simple approach was the chosen strategy in 221 bifurcations (96%). In 90 of these lesions, the side branch was postdilated through the cells of the platform and, in 3 cases, strut fractures were observed in optical coherence tomography. Procedural success was achieved in all patients. There was 1 case of subacute thrombosis and 1 sudden cardiac death during the first month. The duration of angiographic follow-up was 7.3±1.6 months and that of clinical follow-up, 14±6 months. Twelve (5%) restenoses were documented and revascularized. During follow-up, 2 patients (1%) had an infarction in another territory and another 2 patients (1%) died; the remaining patients had a symptom-free follow-up. The incidence of thrombosis was 1.3%. CONCLUSIONS: Treatment of bifurcation coronary lesions using a provisional approach is feasible and safe, with a low rate of adverse events.

Patency of coronary side branches covered by an everolimus-eluting bioresorbable vascular scaffold: clinical outcomes and computed tomography scan follow-up.

AIMS: The behaviour of side branches (SBs) covered by a bioresorbable vascular scaffold (BVS) is not well known. This study analysed the rate of side branch occlusion (SBO) immediately after BVS implantation, its clinical impact, predictors of SBO and the fate of such SBs at follow-up. METHODS AND RESULTS: We assessed 140 patients with 346 jeopardised SBs divided into three groups: small (<1 mm, n=181), intermediate (1-2 mm, n=102) and large (>2 mm, n=63). SBO was defined as a TIMI flow 0 or 1. Computed tomography was scheduled at six months for patients with jailed SBs >1 mm. Immediate occlusion occurred in 31 (9%) SBs: 22 (12%) small, 8 (8%) intermediate and one (1.6%) large, while post-procedural SBO was 5.5%. In-hospital events included one thrombosis (0.7%) and eight non-Q-wave myocardial infarctions (6%). After 17±3 months, one patient died (0.7%) and six patients needed repeat revascularisation (4%). Re-evaluation showed no late SBO at 7±3 months. Predictors of SBO were: small SBs (OR 2.06, 95% CI: 1.08-4.63; p<0.05) and stenosis >50% at the origin (OR 17.22, 95% CI: 7.79-38.10; p<0.01). CONCLUSIONS: The incidence of SBO and its clinical impact were low when SBs >1 mm were covered. These favourable results were maintained at midterm.

Direct bioresorbable vascular scaffold implantation: Feasibility and midterm results.

OBJECTIVES: To analyze the feasibility and safety of direct bioresorbable vascular scaffold (BVS) implantation without previous balloon dilation. BACKGROUND: Lesion preparation through predilation is recommended before BVS implantation. There is no information on the routine use of direct BVS implantation. METHODS AND RESULTS: One hundred fifty-three patients with a total of 200 coronary lesions, were treated with BVS. A baseline intravascular ultrasound study (IVUS) was performed in 171 lesions (86%), and after BVS implantation, the quality of scaffolding was assessed with an additional IVUS (83, 41%) or optical coherence tomography (77, 38%). Elective predilation was conducted in 50 lesions. In 150 lesions, direct BVS implantation was attempted. In 129 lesions (86%), the BVS was implanted successfully, and in the remaining 21 (14%), direct implantation failed. In these cases, the scaffolds were retrieved and successfully implanted after balloon angioplasty. Longer and C-type lesions, and a larger plaque burden, were associated with failure to directly cross the lesion. Balloon postdilation was needed in 34% of the lesions. Ten patients (6.6%) had a periprocedural myocardial infarction. One patient (0.6%) died 60 days after BVS implantation due to thrombosis of the scaffold. At follow-up, target lesion revascularisation was needed in eight patients (5%). After 12 ± 3 months, the remaining patients were symptom-free. CONCLUSIONS: Direct BVS implantation is safe and feasible in most soft coronary plaques.

Stent Repair for Complex Coarctation of Aorta.

OBJECTIVES: This study sought to determine whether several anatomic or evolving characteristics of the coarctation may create challenging conditions for treatment. BACKGROUND: Stent repair of coarctation of aorta is an alternative to surgical correction. METHODS: We analyzed our 21-year experience in the percutaneous treatment of complex coarctation of aorta. Adverse conditions for treatment were as follow: 1) complete interruption of the aortic arch (n = 11); 2) associated aneurysm (n = 18); 3) complex stenosis (n = 30); and 4) the need for re-expansion and/or restenting (n = 21). Twenty patients (33%) belonged to more than 1 group. Ten interruptions were type A and 1 was type B. The mean length of the interrupted aorta was 9 ± 11 mm. The associated aneurysms were native in 8 patients and after previous intervention in 10 patients. Aneurysm shapes were fusiform in 8 patients and saccular in 10. The following characteristics defined complex stenosis as long diffuse stenosis, very tortuous coarctation, or stenosis involving a main branch or an unusual location. Patients previously stented at an early age, required re-expansion and/or restenting after reaching 16 ± 5 years of age. RESULTS: Two patients had died by 1-month follow-up. The remaining 58 patients did well and were followed-up for a mean period of 10 ± 6 years. Late adverse events occurred in 3 patients (5%). All remaining patients are symptom-free, with normal baseline blood pressure. Imaging techniques revealed good patency at follow-up without associated aneurysm or restenosis. The actuarial survival free probability of all complex patients at 15 years was 92%. CONCLUSIONS: Stent repair of complex coarctation of aorta is feasible and safe. Initial results are maintained at later follow-up.

Fracture of Bioresorbable Vascular Scaffold After Side-Branch Balloon Dilation in Bifurcation Coronary Narrowings.

The possibility of strut fractures after bioresorbable vascular scaffold (BVS) treatment is a new problem associated with the use of this novel technology. There is little in vivo information regarding the effects of lateral dilation on BVS. The present study aimed to evaluate the effects of lateral balloon dilation after bioresorbable vascular scaffold implantation in the treatment of bifurcation lesions. From January 2012 to February 2015, 49 patients with bifurcation lesions who had been treated with BVS required balloon dilation of the side branch (SB). Optical coherence tomographic studies were performed in each of these patients. In 3 patients (6%), the optical coherence tomographic results met the criteria for rupture. Prolonged inflation using a noncompliant balloon with a diameter within the expansion limits of the device resolved the complication in all patients. The clinical course was favorable in all patients, and there were no inhospital deaths or myocardial infarctions. At 14 ± 8 months of follow-up, 2 patients with integrity of the BVS presented target lesion revascularization (4%). Another patient (2%) suffered a probable stent thrombosis 11 months after the procedure (myocardial infarction and death at home). The patients with the BVS rupture at the index procedure had a favorable clinical outcome, and the 6-month computed tomographic scan revealed maintenance of the initial good results. In conclusion, minor BVS rupture after 2.5-mm lateral balloon dilation may occur but is infrequent (6%). Prolonged balloon inflation of the main vessel may partially restore the geometry of the BVS.

Diagnostic Approach to Unexplained Cardiac Arrest (from the FIVI-Gen Study).

Unexplained cardiac arrest (UCA) can be caused by low-penetrance genetic disorders. The aim of this cross-sectional study is to assess the usefulness of a new diagnostic protocol: Thirty-five patients were recruited from 9 Spanish centers. Electrocardiogram, echocardiogram, and coronary catheterization were used to rule out electrical or structural heart disease in all subjects. Patients underwent pharmacologic tests with epinephrine and flecainide, followed by assessment of family members using electrocardiogram and echocardiogram, and next-generation genetic sequencing to analyze 126 genes if all the other test results were negative. A firm diagnosis of channelopathy required phenotypic proof of the condition in unmasking tests, the presence of a pathogenic variant consistent with the phenotype observed, and/or co-segregation of the mutation found in a family member's phenotype. A firm diagnosis was made in 18 cases. The diagnoses were 7 Brugada syndrome, 5 catecholaminergic polymorphic ventricular tachycardia, 3 long QT syndrome, 2 early repolarization syndrome, and 1 short QT syndrome. Pharmacologic testing was the most frequent method of diagnosis. In 5 cases, the diagnosis was made based on positive genetic testing without phenotypic alterations. In conclusion, this sequential diagnostic protocol allows diagnoses to be made in approximately half of the UCA cases. These diagnoses are low clinical penetrance channelopathies. If interpreted carefully, genetic tests can be a useful tool for diagnosing UCA without a phenotype.

Structural Damage to Jailed Guidewire During the Treatment of Coronary Bifurcations: Microscopic Evaluation.

INTRODUCTION AND OBJECTIVES: The use of the jailed guidewire technique is highly useful when treating bifurcation lesions by provisional stenting. However, at the time of withdrawal, the guidewire can suffer damage and even fracture. The aim of this study was to evaluate structural damage in both polymer-coated and nonpolymer-coated jailed guidewires. METHODS: Between January 2011 and December 2012, an observational study was conducted using stereoscopic microscopy to evaluate 135 jailed guidewires (45 nonpolymer-coated and 90 polymer-coated) previously used in the percutaneous treatment of bifurcation lesions. Damage after withdrawal was classified as mild, moderate, or severe. RESULTS: Age and sex distributions were similar in both groups of patients treated with polymer-coated and nonpolymer-coated guidewires. However, operators selected polymer-coated guidewires more frequently when treating more complex bifurcations and in diabetic patients. Some type of microscopic damage was observed in 25 of the guidewires analyzed (18%). Paradoxically, damage was more common in nonpolymer-coated guidewires (53.0% vs 1.1%; P<.001). None of the guidewires suffered complete fracture. CONCLUSIONS: Coronary guidewires that are jailed during the treatment of bifurcations using provisional stenting often suffer nonsevere microscopic damage. Although polymer-coated guidewires were used in more complex bifurcation lesions, paradoxically, they were damaged less frequently.

Outcomes and computed tomography scan follow-up of bioresorbable vascular scaffold for the percutaneous treatment of chronic total coronary artery occlusion.

Everolimus-eluting bioresorbable vascular scaffold (BVS) implantation in chronic total occlusion (CTO) could provide theoretical advantages at follow-up compared with metallic stents. This study aimed to assess the feasibility of BVS use for the percutaneous treatment of CTO by analyzing clinical outcomes and patency at midterm follow-up. From February 2013 to June 2014, 42 patients with 46 CTOs were treated by BVS implantation. Once the guidewire reached the distal lumen, all the occluded segments were predilated. Postdilation was performed in all patients. A multislice computed tomography was scheduled for all patients at 6 months. The mean age was 58 ± 9 years, 41 (98%) were men and 14 (33%) diabetic. The target vessel was predominantly the left anterior descending artery (22, 48%). According to the Japanese-CTO score, 21 CTOs (46%) were difficult or very difficult. Most cases were treated with an anterograde strategy (34 lesions, 74%). A hybrid procedure with a drug-eluting stent at the distal segment was the applied treatment in 7 CTOs (15%). The mean scaffold length was 43 ± 21 mm. Technical success was achieved in 45 lesions (98%), and 1 patient (2.4%) presented a non-Q periprocedural myocardial infarction. Re-evaluation was obtained in all patients at 6 ± 1 months. Two re-occlusions and a focal restenosis were identified. After 13 ± 5 months of follow-up, there were 2 repeat revascularizations (4.8%). Neither death nor myocardial infarction was documented. In conclusion, BVS for CTO seems to be an interesting strategy with a high rate of technical success and low rate of cardiac events at midterm follow-up in selected patients.

Three-year follow-up of patients with bifurcation lesions treated with sirolimus- or everolimus-eluting stents: SEAside and CORpal cooperative study.

INTRODUCTION AND OBJECTIVES: To compare the 3-year incidence of major events in patients with bifurcation lesions treated with provisional sirolimus-eluting stents vs everolimus-eluting stents. METHODS: A pooled analysis of 2 prospective randomized trials with similar methodology (SEAside and CORpal) was performed. In these trials, 443 patients with bifurcation lesions were randomly assigned to treatment with either sirolimus-eluting stents or everolimus-eluting stents. The clinical follow-up was extended up to 3 years to assess major adverse cardiovascular events (death or acute myocardial infarction or target vessel revascularization). RESULTS: At 3 years, survival free of major adverse cardiovascular events was 93.2% vs 91.3% in the everolimus-eluting stent group vs the sirolimus-eluting stent group (P = .16). Exploratory land-mark analysis for late events (occurring after 12 months) showed significantly fewer major adverse cardiovascular events in the everolimus-eluting stent group: 1.4% vs 5.4% in the sirolimus-eluting stent group (P = .02). CONCLUSIONS: Provisional stenting with either sirolimus-eluting stents or everolimus-eluting stents in bifurcation lesions is associated with low rates of major adverse events at 3-years' follow-up. The results of a subanalysis of events beyond 1 year, showing a lower event rate with everolimus-eluting stents than with sirolimus-eluting stents, suggest that studies exploring the long-term clinical benefit of the latest generation of drug-eluting stents are warranted.

Assessment of side branch predilation before a provisional T-stent strategy for bifurcation lesions. A randomized trial.

BACKGROUND: A simple approach is the predominant strategy for the percutaneous coronary intervention of bifurcation lesions. Performing side branch (SB) predilation in this context is currently a matter of controversy. In this study, we assess the efficacy of SB predilatation before a provisional T-stent strategy for bifurcation lesions. METHODS: Between February 2009 and November 2012, 372 patients with true bifurcation lesions were randomized to either predilation of the SB (n = 187) or no predilatation (n = 185) before main branch (MB) stent implantation and a subsequent SB provisional stent strategy. RESULTS: There were no significant differences between the patient groups regarding the baseline characteristics. After MB stent implantation, the TIMI flow of the SB was higher in the patients with SB predilation: TIMI flow 0 to 1; 2 (1%) versus 18 (10%), P < .001; and TIMI flow III; 179 (96%) versus 152 (82%), P < .001. Side branch stenting rates were 4% versus 3%, P = not significant. In addition, 60 patients (32%) from the SB predilation group presented SB residual stenosis by visual inspection <50%, and TIMI flow ≥III did not require any additional treatment. The failure rate of SB rewiring, the time of rewiring, the number of wires used, and the incidence of major events were similar in both groups of patients. CONCLUSIONS: Predilation of the SB resulted in improved TIMI flow after MB stenting and less indication to subsequently treat the SB. If rewiring of the SB is required, predilation did not hinder this maneuver.