Bifurcation left main stenting with or without intracoronary imaging: Outcomes from the EBC MAIN trial.
Catheter Cardiovasc Interv
; 102(3): 415-429, 2023 09.
Article
en En
| MEDLINE
| ID: mdl-37473405
ABSTRACT
BACKGROUND:
The impact of intracoronary imaging on outcomes, after provisional versus dual-stenting for bifurcation left main (LM) lesions, is unknown.OBJECTIVES:
We investigated the effect of intracoronary imaging in the EBC MAIN trial (European Bifurcation Club LM Coronary Stent study).METHODS:
Four hundred and sixty-seven patients were randomized to dual-stenting or a stepwise provisional strategy. Four hundred and fifty-five patients were included. Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was undertaken at the operator's discretion. The primary endpoint was death, myocardial infarction or target vessel revascularization at 1-year.RESULTS:
Intracoronary imaging was undertaken in 179 patients (39%; IVUS = 151, OCT = 28). As a result of IVUS findings, operators reintervened in 42 procedures. The primary outcome did not differ with intracoronary imaging versus angiographic-guidance (17% vs. 16%; odds ratio [OR] 0.92 (95% confidence interval [CI] 0.51-1.63) p = 0.767), nor for reintervention based on IVUS versus none (14% vs. 16%; OR 0.88 [95% CI 0.32-2.43] p = 0.803), adjusted for syntax score, lesion calcification and ischemic symptoms. With angiographic-guidance, primary outcome events were more frequent with dual versus provisional stenting (21% vs. 10%; adjusted OR 2.11 [95% CI 1.04-4.30] p = 0.039). With intracoronary imaging, there were numerically fewer primary outcome events with dual versus provisional stenting (13% vs. 21%; adjusted OR 0.56 [95% CI 0.22-1.46] p = 0.220).CONCLUSIONS:
In EBC MAIN, the primary outcome did not differ with intracoronary imaging versus none. However, in patients with angiographic-guidance, outcomes were worse with a dual-stent than provisional strategy When intracoronary imaging was used, there was a trend toward better outcomes with the dual-stent than provisional strategy.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Enfermedad de la Arteria Coronaria
/
Intervención Coronaria Percutánea
/
Infarto del Miocardio
Tipo de estudio:
Clinical_trials
/
Etiology_studies
Límite:
Humans
Idioma:
En
Año:
2023
Tipo del documento:
Article