Randomized study on simple versus complex stenting of coronary artery bifurcation lesions : The nordic bifurcation study

• Published in: Circulation (New York, N.Y.) N.Y.), 2006-10, Vol.114 (18), p.1955-1961
• Main Authors: STEIGEN, Terje K, MAENG, Michael, NIEMELÄ, Matti, KERVINEN, Kari, JENSEN, Jan S, GALLØE, Anders, NIKUS, Kjell, VIKMAN, Saila, RAVKILDE, Jan, JAMES, Stefan, AARØE, Jens, YLITALO, Antti, WISETH, Rune, HELQVIST, Steffen, SJÖGREN, Iwar, THAYSSEN, Per, VIRTANEN, Kari, PUHAKKA, Mikko, AIRAKSINEN, Juhani, LASSEN, Jens F, THUESEN, Leif, ERGLIS, Andrejs, KUMSARS, Indulis, NARBUTE, Inga, GUNNES, Pal, MANNSVERK, Jan, MEYERDIERKS, Oliver, ROTEVATN, Svein
• Format: Article
• Language: English
• Subjects: angiography; angioplasty; bifurcation; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular system; Coronary Angiography; Coronary heart disease; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - epidemiology; Coronary Stenosis - surgery; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; MEDICIN; MEDICINE; Middle Aged; Pharmacology. Drug treatments; restenosis; Sirolimus - administration & dosage; Sirolimus - therapeutic use; stenosis; Stents; Treatment Outcome; Vasodilator agents. Cerebral vasodilators
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.106.664920

The optimal stenting strategy in coronary artery bifurcation lesions is unknown. In the present study, a strategy of stenting both the main vessel and the side branch (MV+SB) was compared with a strategy of stenting the main vessel only, with optional stenting of the side branch (MV), with sirolimus-eluting stents. A total of 413 patients with a bifurcation lesion were randomized. The primary end point was a major adverse cardiac event: cardiac death, myocardial infarction, target-vessel revascularization, or stent thrombosis after 6 months. At 6 months, there were no significant differences in rates of major adverse cardiac events between the groups (MV+SB 3.4%, MV 2.9%; P=NS). In the MV+SB group, there were significantly longer procedure and fluoroscopy times, higher contrast volumes, and higher rates of procedure-related increases in biomarkers of myocardial injury. A total of 307 patients had a quantitative coronary assessment at the index procedure and after 8 months. The combined angiographic end point of diameter stenosis >50% of main vessel and occlusion of the side branch after 8 months was found in 5.3% in the MV group and 5.1% in the MV+SB group (P=NS). Independent of stenting strategy, excellent clinical and angiographic results were obtained with percutaneous treatment of de novo coronary artery bifurcation lesions with sirolimus-eluting stents. The simple stenting strategy used in the MV group was associated with reduced procedure and fluoroscopy times and lower rates of procedure-related biomarker elevation. Therefore, this strategy can be recommended as the routine bifurcation stenting technique.