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Simple or complex stenting for bifurcation coronary lesions: a patient-level pooled-analysis of the Nordic Bifurcation study and the British Bifurcation Coronary Study

Simple or complex stenting for bifurcation coronary lesions: a patient-level pooled-analysis of the Nordic Bifurcation study and the British Bifurcation Coronary Study
Simple or complex stenting for bifurcation coronary lesions: a patient-level pooled-analysis of the Nordic Bifurcation study and the British Bifurcation Coronary Study
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).

METHODS AND 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.
coronary, bifurcation, stent
1941-7640
57-64
Behan, Miles W.
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Holm, Niels R.
ca75dded-fb63-4dbc-90fa-4ae2c29148f3
Curzen, Nicholas P.
70f3ea49-51b1-418f-8e56-8210aef1abf4
Andrejs, Erglis
8394bc33-00ed-4a3c-a3c4-8dfc4600d815
Stables, Rodney H.
27cf211c-da55-4292-b66d-1963be161e32
de Belder, Adam J.
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Niemalä, Matti
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Cooter, Nina
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Chew, Derek P.
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Steigen, Tenje K.
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Oldroyd, Keith G.
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Jensen, Jan S.
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Flensted Lassen, Jens
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Thuesen, Jens
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Hildick-Smith, David
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Behan, Miles W.
0d167841-2c3a-425f-92fa-cb091a85b22f
Holm, Niels R.
ca75dded-fb63-4dbc-90fa-4ae2c29148f3
Curzen, Nicholas P.
70f3ea49-51b1-418f-8e56-8210aef1abf4
Andrejs, Erglis
8394bc33-00ed-4a3c-a3c4-8dfc4600d815
Stables, Rodney H.
27cf211c-da55-4292-b66d-1963be161e32
de Belder, Adam J.
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Niemalä, Matti
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Cooter, Nina
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Chew, Derek P.
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Steigen, Tenje K.
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Oldroyd, Keith G.
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Jensen, Jan S.
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Flensted Lassen, Jens
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Thuesen, Jens
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Hildick-Smith, David
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Behan, Miles W., Holm, Niels R., Curzen, Nicholas P., Andrejs, Erglis, Stables, Rodney H., de Belder, Adam J., Niemalä, Matti, Cooter, Nina, Chew, Derek P., Steigen, Tenje K., Oldroyd, Keith G., Jensen, Jan S., Flensted Lassen, Jens, Thuesen, Jens and Hildick-Smith, David (2011) Simple or complex stenting for bifurcation coronary lesions: a patient-level pooled-analysis of the Nordic Bifurcation study and the British Bifurcation Coronary Study. Circulation Cardiovascular Interventions, 4 (1), 57-64. (doi:10.1161/circinterventions.110.958512). (PMID:21205942)

Record type: Article

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).

METHODS AND 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.

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e-pub ahead of print date: 4 January 2011
Published date: February 2011
Keywords: coronary, bifurcation, stent
Organisations: Human Development & Health

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Local EPrints ID: 355219
URI: https://eprints.soton.ac.uk/id/eprint/355219
ISSN: 1941-7640
PURE UUID: 5f0a1073-41e7-4df3-a8d9-1bd024d04397

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Date deposited: 13 Aug 2013 14:38
Last modified: 16 Jul 2019 21:27

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Contributors

Author: Miles W. Behan
Author: Niels R. Holm
Author: Erglis Andrejs
Author: Rodney H. Stables
Author: Adam J. de Belder
Author: Matti Niemalä
Author: Nina Cooter
Author: Derek P. Chew
Author: Tenje K. Steigen
Author: Keith G. Oldroyd
Author: Jan S. Jensen
Author: Jens Flensted Lassen
Author: Jens Thuesen
Author: David Hildick-Smith

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